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How to differentiate benign from malignant myometrial tumours using MR imaging

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Abstract

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.

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Authors and Affiliations

  1. Department of Radiology, Hôpital Tenon, Assistance Publique–Hôpitaux de Paris and Université Pierre et Marie Curie, Paris, France

    Isabelle Thomassin-Naggara, Sophie Dechoux, Audrey Morel, Marie-France Carette & Marc Bazot

  2. Department of Gynecology-Obstetrics, Hôpital Tenon, Assistance Publique–Hôpitaux de Paris and Université Pierre et Marie Curie, Paris, France

    Claire Bonneau, Roman Rouzier & Emile Daraï

  3. Service de Radiologie, Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France

    Isabelle Thomassin-Naggara

Authors
  1. Isabelle Thomassin-Naggara
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  2. Sophie Dechoux
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  3. Claire Bonneau
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  4. Audrey Morel
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  5. Roman Rouzier
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  6. Marie-France Carette
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  7. Emile Daraï
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  8. Marc Bazot
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Corresponding author

Correspondence to Isabelle Thomassin-Naggara.

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Thomassin-Naggara, I., Dechoux, S., Bonneau, C. et al. How to differentiate benign from malignant myometrial tumours using MR imaging. Eur Radiol 23, 2306–2314 (2013). https://doi.org/10.1007/s00330-013-2819-9

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  • DOI: https://doi.org/10.1007/s00330-013-2819-9

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