Uterine sarcomas: Computed tomography and magnetic resonance imaging findings

To summarize and analyze the computed tomography (CT) and magnetic resonance imaging (MRI) features of uterine sarcoma.

This retrospective study reviewed the clinical data and CT/MRI findings of 15 patients with uterine sarcomas confirmed by surgery and pathology, focusing on their characteristic imaging manifestations.

Among the 15 patients, eight had uterine smooth muscle sarcoma (four with lesions confined to the uterine cavity and four presenting as large pelvic masses; all were cystic); one had undifferentiated uterine sarcoma [low signal on TI-weighted imaging (T1WI), high signal on T2-weighted imaging (T2WI) with the clear border, and marginal ring-shaped high signals on diffusion-weighted image (DWI)]; two had uterine adenosarcoma (mixed-density nodular and mass-like lesions with marked heterogeneous enhancement); three had low-grade endometrial stromal sarcoma (iso- or hypointense on T1WI, hyper- or slightly hyperintense on T2WI, and markedly hyperintense on DWI); and one had high-grade endometrial stromal sarcoma (a large cystic-solid pelvic mass). Pathology confirmed that this last lesion invaded the plasma membrane and involved local sub-plasma tissue of the intestinal wall.

Uterine sarcoma commonly presents as the large cystic pelvic mass with indistinct margins, irregular shape, and possible invasion of adjacent structures. MRI typically shows iso- or slightly low T1WI signals, mixed high T2WI signals, high or slightly high DWI signals, and heterogeneous enhancement. These findings may aid in improving diagnostic accuracy and guiding clinical management of uterine sarcoma.