Uterine leiomyomas: correlation of MR, histopathologic findings, and symptoms

Magnetic resonance (MR) imaging, symptoms, and pathologic findings were correlated in 59 uterine leiomyomas from 23 patients. The tumors varied from less than 1 cm to 18 cm in diameter. Fifty-seven leiomyomas were identified in the corpus uterus, one was located within the broad ligament, and another was detected in the cervix. Among the corpus lesions, 9 were correctly identified on MR images as subserosal and 37 as intramural. Of 11 tumors assigned at surgery to the submucosal group, 10 had been accurately defined with MR. On MR, myomas associated with hypermenorrhea produced an anatomic disruption of the "junctional zone" (the low-intensity band seen at the myometrium-endometrium junction on T2 contrast images). Long TR (2 sec) and TE (56 msec) parameters (T2 contrast images) yielded the best contrast resolution between leiomyoma and surrounding myometrium. Correlation of MR with histologic features demonstrated 2 groups of lesions. Leiomyomas free of degenerative changes emitted homogeneous signals of low intensity. Contrast between tumor and myometrium was -16% on the T1 contrast image and increased to -44 +/- 16% on the T2 contrast image. Leiomyomas with hyaline, myxomatous, or fatty degeneration demonstrated various degrees of inhomogeneity, best seen on images obtained with long TR and TE. It is concluded that MR is an accurate modality for imaging uterine leiomyomas, since it clearly demonstrates tumor number, size, location, and the presence and extent of degeneration.