How to differentiate benign from malignant myometrial tumours using MR imaging

Purpose

To retrospectively evaluate the ability of magnetic resonance imaging (MRI) to differentiate malignant from benign myometrial tumours.

Methods

Fifty-one women underwent MRI before surgery for evaluation of a solitary myometrial tumour. At histopathology, there were 25 uncertain or malignant mesenchymal tumours and 26 benign leiomyomas. Conventional morphological MRI criteria were recorded in addition to b _1,000 signal intensity and apparent diffusion coefficient (ADC). Odds ratios (OR) were calculated for each criterion. A multivariate analysis was performed to construct an interpretation model.

Results

The significant criteria for prediction of malignancy were high b _1,000 signal intensity (OR?=?+∞), intermediate T2-weighted signal intensity (OR?=?+∞), mean ADC (OR?=?25.1), patient age (OR?=?20.1), intra-tumoral haemorrhage (OR?=?21.35), endometrial thickening (OR?=?11), T2-weighted signal heterogeneity (OR?=?10.2), menopausal status (OR?=?9.7), heterogeneous enhancement (OR?=?8) and non-myometrial origin on MRI (OR?=?4.9). In the recursive partitioning model, using b _1,000 signal intensity, T2 signal intensity, mean ADC, and patient age, the model correctly classified benign and malignant tumours in 47 of the 51 cases (92.4 %).

Conclusion

We have developed an interpretation model usable in routine practice for myometrial tumours discovered at MRI including T2 signal, b _1,000 signal and ADC measurement.

Key Points

? MRI is widely used to differentiate benign from malignant myometrial tumours. ? By combining T2-weighted, b _1,000 and ADC features, MRI is 92.4?% accurate. ? DWI may limit misdiagnoses of uterine sarcoma as benign leiomyoma. ? Patient age is important when considering a solitary myometrial tumour.