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Review of uterine fibroids: imaging of typical and atypical features, variants, and mimics with emphasis on workup and FIGO classification

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Abstract

Uterine fibroids are the most common gynecologic neoplasm. Although non-degenerated fibroids are easily identifiable on imaging, degenerated fibroids, fibroid variants, and fibroids with unusual growth patterns can constitute a diagnostic dilemma. Identification of these abnormal morphologic features can alter the diagnosis of presumed uterine fibroids and hence change management plans. This article reviews the typical and atypical radiologic imaging features of uterine fibroids, with an emphasis on the pitfalls, mimics, and radiologically identifiable features that can alter clinical management plans.

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Abbreviations

ADC:

Apparent diffusion coefficient

CT:

Computerized tomography

DMPA:

Depot-medroxyprogesterone acetate

DWI:

Diffusion-weighted imaging

FIGO:

Fédération Internationale de Gynécologie et d’Obstétrique

FDG:

18F-fluorodeoxyglucose

GnRH:

Gonadotropin-releasing hormone

HPF:

High-power fields

IUD:

Intrauterine devices

MRI:

Magnetic resonance imaging

PET:

Positron emission tomography

STUMP:

Smooth muscle tumor of uncertain malignant potential

SUVmax:

Maximum standard uptake value

UAE:

Uterine artery embolization

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Authors and Affiliations

  1. Division of Diagnostic Imaging, Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Houston, Texas, 77030, USA

    Muhammad O. Awiwi, Mohamed Badawy, Corey T. Jensen, Juan J. Ibarra-Rovira & Khaled M. Elsayes

  2. Department of Radiology, University of Utah, Salt Lake City, USA

    Akram M. Shaaban

  3. Department of Diagnostic Radiology, Mayo Clinic, Scottsdale, AZ, USA

    Christine O. Menias

  4. Department of Radiology, Northwestern University, Illinois, USA

    Jeanne M. Horowitz & Moataz Soliman

  5. Department of Radiology, University of Missouri, Columbia, MO, USA

    Ayman H. Gaballah

  6. Department of Radiology, Cleveland Clinic, Cleveland, OH, USA

    Myra K. Feldman

  7. Department of Radiology, University of Texas Health Science Center at Houston, Houston, TX, USA

    Mindy X. Wang & Peter S. Liu

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  1. Muhammad O. Awiwi
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All authors contributed to the study conception and design. The manuscript was written by MOA. All authors commented on the initial draft and approved the final manuscript.

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Correspondence to Muhammad O. Awiwi.

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Awiwi, M.O., Badawy, M., Shaaban, A.M. et al. Review of uterine fibroids: imaging of typical and atypical features, variants, and mimics with emphasis on workup and FIGO classification. Abdom Radiol 47, 2468–2485 (2022). https://doi.org/10.1007/s00261-022-03545-x

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