Angela Tong1, Stella K Kang1,2, Chenchan Huang1, Kathy Huang3, Adam Slevin3, Nicole Hindman1. 1. Department of Radiology, New York University Langone Health, New York, New York, USA. 2. Department of Population Health, New York University Langone Health, New York, New York, USA. 3. Department of Obstetrics and Gynecology, New York University Langone Health, New York, New York, USA.
Abstract
BACKGROUND: Uterine fibroids are a common benign tumor and can be symptomatic, necessitating resection. Surgical myomectomy is an effective treatment option with a risk of disseminating occult uterine leiomyosarcoma (LMS), creating a need for an effective presurgical screening protocol. Clinical collaboration with contrast-enhanced MRI including T2 and diffusion-weighted imaging (DWI) can be utilized as a screening exam. PURPOSE: To review the accuracy and feasibility of an interdisciplinary prospective contrast-enhanced MRI pelvis with DWI screening system for LMS prior to fibroid resection. STUDY TYPE: Retrospective cohort study. POPULATION: In all, 1960 adult female patients aged 18-87 undergoing screening MRI pelvis prior to uterine fibroid resection. FIELD STRENGTH/SEQUENCE: T1 and T2 -weighted imaging, DWI, and contrast-enhanced images were acquired at 1.5 T and 3.0 T. ASSESSMENT: Each radiologist at the time of clinical study prospectively designated a confidence level of presence of LMS in the impression, which was reviewed retrospectively. A separate retrospective evaluation of the histologically proven LMS and the false positives was performed for the presence of five MRI features of LMS including low ADC values, intermediate/high T2 signal intensity, irregular margins, hemorrhage, and necrosis. A preliminary cost-effectiveness analysis was performed, comparing the costs of treatment of uterine fibroids with vs. without a collaborative screening protocol using MRI. STATISTICAL TESTS: Sensitivity, specificity, positive predictive value, and negative predictive value were obtained from the prospective evaluations. Student's t-tests were used to compare demographics and apparent diffusion coefficient values between LMS and false-positive results. RESULTS: We prospectively identified LMS patients with 100% sensitivity and 97% specificity. Preliminary cost analysis demonstrated that the MR screening protocol increased life expectancy by 0.04 years at a cost of $12,937 per life-year gained. DATA CONCLUSION: MRI is an effective and potentially economic screening test, especially with standardized reporting and coordination with clinicians. LEVEL OF EVIDENCE: 3 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2019.
BACKGROUND: Uterine fibroids are a common benign tumor and can be symptomatic, necessitating resection. Surgical myomectomy is an effective treatment option with a risk of disseminating occult uterine leiomyosarcoma (LMS), creating a need for an effective presurgical screening protocol. Clinical collaboration with contrast-enhanced MRI including T2 and diffusion-weighted imaging (DWI) can be utilized as a screening exam. PURPOSE: To review the accuracy and feasibility of an interdisciplinary prospective contrast-enhanced MRI pelvis with DWI screening system for LMS prior to fibroid resection. STUDY TYPE: Retrospective cohort study. POPULATION: In all, 1960 adult female patients aged 18-87 undergoing screening MRI pelvis prior to uterine fibroid resection. FIELD STRENGTH/SEQUENCE: T1 and T2 -weighted imaging, DWI, and contrast-enhanced images were acquired at 1.5 T and 3.0 T. ASSESSMENT: Each radiologist at the time of clinical study prospectively designated a confidence level of presence of LMS in the impression, which was reviewed retrospectively. A separate retrospective evaluation of the histologically proven LMS and the false positives was performed for the presence of five MRI features of LMS including low ADC values, intermediate/high T2 signal intensity, irregular margins, hemorrhage, and necrosis. A preliminary cost-effectiveness analysis was performed, comparing the costs of treatment of uterine fibroids with vs. without a collaborative screening protocol using MRI. STATISTICAL TESTS: Sensitivity, specificity, positive predictive value, and negative predictive value were obtained from the prospective evaluations. Student's t-tests were used to compare demographics and apparent diffusion coefficient values between LMS and false-positive results. RESULTS: We prospectively identified LMS patients with 100% sensitivity and 97% specificity. Preliminary cost analysis demonstrated that the MR screening protocol increased life expectancy by 0.04 years at a cost of $12,937 per life-year gained. DATA CONCLUSION: MRI is an effective and potentially economic screening test, especially with standardized reporting and coordination with clinicians. LEVEL OF EVIDENCE: 3 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2019.