Diagnostic Performance of MRI to Differentiate Uterine Leiomyosarcoma from Benign Leiomyoma: A Meta-Analysis

To perform a meta-analysis comparing the diagnostic performance of increased signal intensity on T1- and T2-weighted magnetic resonance images and apparent diffusion coefficient (ADC) values in differentiating uterine leiomyosarcoma (LMS) from benign leiomyoma (LM).

A systematic literature search for original studies was performed using PubMed/MEDLINE, the Cochrane Library, Embase, and Web of Science. Data necessary for the meta-analysis was extracted from the selected articles and analyzed.

Eight studies with 795 patients met our predefined inclusion criteria and were included in the analysis. Increased signal on T1-weighted imaging had a pooled sensitivity of 56.8% (95% CI: 20%-87.4%) for LMS (n = 60) which was significantly higher than 7.6% (95% CI: 2.2%-22.7%) for LM (n = 1272) (p = 0.0094). Increased signal analysis on T2-weighted imaging had a pooled sensitivities of 93.2% and 93.2% (95% CI: 45.7%-99.6% and 42.9%-99.6%) for LMS (n = 90), which were not significantly different from the 54.5% and 53.9% (95% CI: 33.6%-74%, 32%-74%) for LM (n = 215) (p = 0.102 and 0.112). On ADC value analysis, LMS (n = 43) had a weighted mean and standard deviation of 0.896 ± 0.19 10^-3 mm²/s, 0.929 ± 0.182 10^-3 mm²/s, which were significantly lower from 1.258 ± 0.303 10^-3 mm²/s, 1.304 ± 0.303 10^-3 mm²/s for LM (n = 159) (p = < 0.0001, < 0.0001).

Our meta-analysis demonstrated that high signal intensity on T1-weighted images and low ADC values can accurately differentiate LMS from LM. Although, LMS had a higher pooled sensitivity for T2-weighted increased signal intensity compared to LM, there was no statistical significance.