Hilal Sahin1,2,3, Janette Smith4, Jeries Paolo Zawaideh4, Amreen Shakur4, Luca Carmisciano5, Iztok Caglic4, Annemarie Bruining6, Mercedes Jimenez-Linan7, Sue Freeman4, Helen Addley2,4. 1. Department of Radiology, School of Clinical Medicine, University of Cambridge, Cambridge, UK. 2. Cancer Research UK Cambridge Centre, University of Cambridge, Cambridge, UK. 3. Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey. 4. Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. 5. Department of Health Sciences (DISSAL), Biostatistics section, University of Genoa, Genoa, Italy. 6. Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands. 7. Department of Histopathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Abstract
OBJECTIVE: To assess the value of non-contrast MRI features for characterisation of uterine leiomyosarcoma (LMS) and differentiation from atypical benign leiomyomas. METHODS: This study included 57 atypical leiomyomas and 16 LMS which were referred pre-operatively for management review to the specialist gynaeoncology multidisciplinary team meeting. Non-contrast MRIs were retrospectively reviewed by five independent readers (three senior, two junior) and a 5-level Likert score (1-low/5-high) was assigned to each mass for likelihood of LMS. Evaluation of qualitative and quantitative MRI features was done using uni- and multivariable regression analysis. Inter-reader reliability for the assessment of MRI features was calculated by using Cohen's κ values. RESULTS: In the univariate analysis, interruption of the endometrial interface and irregular tumour shape had the highest odds ratios (ORs) (64.00, p < 0.001 and 12.00, p = 0.002, respectively) for prediction of LMS. Likert score of the mass was significant in prediction (OR, 3.14; p < 0.001) with excellent reliability between readers (ICC 0.86; 95% CI, 0.76-0.92). The post-menopausal status, interruption of endometrial interface and thickened endometrial stripe were the most predictive independent variables in multivariable estimation of the risk of leiomyosarcoma with an accuracy of 0.88 (95%CI, 0.78-0.94). CONCLUSION: At any level of expertise as a radiologist reader, the loss of the normal endometrial stripe (either thickened or not seen) in a post-menopausal patient with a myometrial mass was highly likely to be LMS. ADVANCES IN KNOWLEDGE: This study demonstrates the potential utility of non-contrast MRI features in characterisation of LMS over atypical leiomyomas, and therefore influence on optimal management of these cases.
OBJECTIVE: To assess the value of non-contrast MRI features for characterisation of uterine leiomyosarcoma (LMS) and differentiation from atypical benign leiomyomas. METHODS: This study included 57 atypical leiomyomas and 16 LMS which were referred pre-operatively for management review to the specialist gynaeoncology multidisciplinary team meeting. Non-contrast MRIs were retrospectively reviewed by five independent readers (three senior, two junior) and a 5-level Likert score (1-low/5-high) was assigned to each mass for likelihood of LMS. Evaluation of qualitative and quantitative MRI features was done using uni- and multivariable regression analysis. Inter-reader reliability for the assessment of MRI features was calculated by using Cohen's κ values. RESULTS: In the univariate analysis, interruption of the endometrial interface and irregular tumour shape had the highest odds ratios (ORs) (64.00, p < 0.001 and 12.00, p = 0.002, respectively) for prediction of LMS. Likert score of the mass was significant in prediction (OR, 3.14; p < 0.001) with excellent reliability between readers (ICC 0.86; 95% CI, 0.76-0.92). The post-menopausal status, interruption of endometrial interface and thickened endometrial stripe were the most predictive independent variables in multivariable estimation of the risk of leiomyosarcoma with an accuracy of 0.88 (95%CI, 0.78-0.94). CONCLUSION: At any level of expertise as a radiologist reader, the loss of the normal endometrial stripe (either thickened or not seen) in a post-menopausal patient with a myometrial mass was highly likely to be LMS. ADVANCES IN KNOWLEDGE: This study demonstrates the potential utility of non-contrast MRI features in characterisation of LMS over atypical leiomyomas, and therefore influence on optimal management of these cases.
Authors: S Sun; P A Bonaffini; S Nougaret; L Fournier; A Dohan; J Chong; J Smith; H Addley; C Reinhold Journal: Diagn Interv Imaging Date: 2019-08-16 Impact factor: 4.026
Authors: P Rahimifar; H Hashemi; M Malek; S Ebrahimi; E Tabibian; A Alidoosti; A Mousavi; F Yarandi Journal: Clin Radiol Date: 2019-04-20 Impact factor: 2.350
Authors: Muhammad O Awiwi; Mohamed Badawy; Akram M Shaaban; Christine O Menias; Jeanne M Horowitz; Moataz Soliman; Corey T Jensen; Ayman H Gaballah; Juan J Ibarra-Rovira; Myra K Feldman; Mindy X Wang; Peter S Liu; Khaled M Elsayes Journal: Abdom Radiol (NY) Date: 2022-05-13