Gigin Lin1, Lan-Yan Yang2, Yu-Ting Huang1, Koon-Kwan Ng1, Shu-Hang Ng1, Shir-Hwa Ueng3, Angel Chao4, Tzu-Chen Yen5, Ting-Chang Chang4, Chyong-Huey Lai4. 1. Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital and Institute for Radiological Research, Chang Gung University, Linkou Medical Center, Guishan, Taoyuan, Taiwan. 2. Clinical Trial Center, Chang Gung Memorial Hospital and Chang Gung University, Linkou Medical Center, Guishan, Taoyuan, Taiwan. 3. Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University, Linkou Medical Center, Guishan, Taoyuan, Taiwan. 4. Department of Obstetrics and Gynecology, Gynecology Oncology Research Center, Chang Gung Memorial Hospital and Chang Gung University, Linkou Medical Center, Guishan, Taoyuan, Taiwan. 5. Department of Nuclear Medicine and Center for Advanced Molecular Imaging and Translation, Chang Gung Memorial Hospital and Chang Gung University, Linkou Medical Center, Guishan, Taoyuan, Taiwan.
Abstract
PURPOSE: To compare the diagnostic accuracy of contrast-enhanced (CE) magnetic resonance imaging (MRI) and diffusion-weighted MRI (DWI) in the differentiation between uterine leiomyosarcoma (LMS) / smooth muscle tumor with uncertain malignant potential (STUMP) and benign leiomyoma. MATERIALS AND METHODS: A consecutive cohort of 8 LMS/STUMP and 25 benign leiomyomas underwent pelvic MRI exam at 3T. Two radiologists independently evaluated images based on CE-MRI (central nonenhancement at equilibrial phase) and DWI (hyperintensity on b = 1000 s/mm2 and hypointensity on apparent diffusion coefficients [ADC] map). The ADC values were calculated from b = 0 and 1000 s/mm2 . RESULTS: CE-MRI yielded a significantly superior diagnostic accuracy (0.94 vs. 0.52) and a significantly higher specificity (0.96 vs. 0.36) than DWI (P < 0.05 for both), and remained a comparably high sensitivity as DWI (0.88 vs. 1.00). A combination of DWI and ADC value <1.08 × 10(-3) mm2 /s (determined by receiver operating characteristic analysis) improved diagnostic accuracy, sensitivity, and specificity of DWI to 0.88, 0.88, and 0.88, respectively, by post-hoc analysis based on the same study cohort. CONCLUSION: For prospective differentiation between uterine LMS/STUMP and benign leiomyoma, CE-MRI can provide accurate information and is preferable to DWI. Combination of DWI and ADC values can achieve a comparable diagnostic accuracy to CE-MRI.
PURPOSE: To compare the diagnostic accuracy of contrast-enhanced (CE) magnetic resonance imaging (MRI) and diffusion-weighted MRI (DWI) in the differentiation between uterine leiomyosarcoma (LMS) / smooth muscle tumor with uncertain malignant potential (STUMP) and benign leiomyoma. MATERIALS AND METHODS: A consecutive cohort of 8 LMS/STUMP and 25 benign leiomyomas underwent pelvic MRI exam at 3T. Two radiologists independently evaluated images based on CE-MRI (central nonenhancement at equilibrial phase) and DWI (hyperintensity on b = 1000 s/mm2 and hypointensity on apparent diffusion coefficients [ADC] map). The ADC values were calculated from b = 0 and 1000 s/mm2 . RESULTS: CE-MRI yielded a significantly superior diagnostic accuracy (0.94 vs. 0.52) and a significantly higher specificity (0.96 vs. 0.36) than DWI (P < 0.05 for both), and remained a comparably high sensitivity as DWI (0.88 vs. 1.00). A combination of DWI and ADC value <1.08 × 10(-3) mm2 /s (determined by receiver operating characteristic analysis) improved diagnostic accuracy, sensitivity, and specificity of DWI to 0.88, 0.88, and 0.88, respectively, by post-hoc analysis based on the same study cohort. CONCLUSION: For prospective differentiation between uterine LMS/STUMP and benign leiomyoma, CE-MRI can provide accurate information and is preferable to DWI. Combination of DWI and ADC values can achieve a comparable diagnostic accuracy to CE-MRI.
Authors: Rim Abou Chakra; Bernard Najib; Wael Abdallah; Mira Akiki; Lea El Khoury; Ali Atoui; Malak Moubarak; David Atallah Journal: Case Rep Oncol Date: 2021-06-17