Magnetic resonance imaging features of uterine adenosarcoma: case series and systematic review

To comprehensively summarize the characteristics of magnetic resonance imaging (MRI) findings of uterine adenosarcoma through a systematic review and case series analysis.

A literature search was conducted in MEDLINE, Scopus, and Embase databases on June 3, 2024. In total, 25 cases from 23 articles were selected, and five cases from the authors' institution were included. Two board-certified radiologists evaluated the demographic, clinical, and radiological data.

The median age at diagnosis was 48.5 years (range: 9-79 years). The most frequent chief complaint was abnormal bleeding (96.7%), pathological T1 stage was predominant (85.2%), and 55.2% of the patients had sarcomatous overgrowth. Locoregional/distant recurrence occurred in 36.4% of the patients. MRI findings revealed that the mean longest lesion size was 9.3 cm. However, most lesions were located in the uterine body (93.1%) and primarily involved the endometrium (96.6%). Most cases (90.0%) were polypoid lesions with 80.8% protruding into the cervical canal. Cystic changes were prevalent (96.5%) and hemorrhage was observed in 84.6% of the evaluated cases. Lesions showed high (51.7%) or intermediate (48.3%) signal intensity compared with the uterine myometrium on T2-weighted imaging. Furthermore, all lesions showed heterogeneous enhancement on contrast-enhanced MRI, and the mean apparent diffusion coefficient value was 1.05 × 10^-3 mm²/s.

Our findings provide a comprehensive analysis of MRI features in uterine adenosarcoma cases, highlighting key characteristics that may aid in preoperative diagnosis and differentiation from other uterine malignancies.