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MRI screening for uterine leiomyosarcoma.

Angela Tong1, Stella K Kang1,2, Chenchan Huang1

  • 1Department of Radiology, New York University Langone Health, New York, New York, USA.

Journal of Magnetic Resonance Imaging : JMRI
|January 15, 2019
PubMed
Summary

Contrast-enhanced MRI with diffusion-weighted imaging (DWI) effectively screens for uterine leiomyosarcoma (LMS) before fibroid resection. This MRI protocol is accurate, potentially economic, and improves patient outcomes.

Keywords:
collaborativeleiomyosarcomascreening MRIuterine fibroid

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Area of Science:

  • Radiology
  • Oncology
  • Gynecology

Background:

  • Uterine fibroids are common benign tumors requiring resection.
  • Surgical myomectomy carries a risk of disseminating occult uterine leiomyosarcoma (LMS).
  • An effective presurgical screening protocol for LMS is needed.

Purpose of the Study:

  • To evaluate the accuracy and feasibility of an interdisciplinary, prospective, contrast-enhanced MRI pelvis with DWI screening system for LMS prior to uterine fibroid resection.

Main Methods:

  • A retrospective cohort study of 1960 adult female patients undergoing screening MRI pelvis.
  • MRI sequences included T1 and T2-weighted imaging, DWI, and contrast-enhanced images at 1.5 T and 3.0 T.
  • Radiologists prospectively assessed LMS presence; retrospective analysis evaluated specific MRI features of LMS and false positives.

Main Results:

  • The MRI screening protocol achieved 100% sensitivity and 97% specificity for identifying LMS.
  • Preliminary cost analysis indicated a gain of 0.04 life-years at a cost of $12,937 per life-year gained.

Conclusions:

  • Contrast-enhanced MRI with DWI is an effective presurgical screening tool for uterine leiomyosarcoma.
  • This MRI protocol is potentially economic, especially with standardized reporting and clinician coordination.
  • The screening improves patient outcomes and life expectancy.