How I Do It: Identifying Signs to Differentiate Uterine Sarcoma (Leiomyosarcoma) from Leiomyomas at MRI

The prevalence of uterine sarcoma, typically leiomyosarcoma, is greater than previously believed, with current data indicating a risk as high as one in 770 women undergoing surgery for presumed leiomyomas (uterine fibroids). Presurgical detection of uterine sarcoma is an important clinical concern for gynecologists and gynecologic oncologists worldwide. Inadvertent minimally invasive treatment of unsuspected uterine leiomyosarcoma may delay definitive therapy or lead to disease dissemination. Contrast-enhanced MRI with diffusion-weighted imaging and apparent diffusion coefficient measurement provides high accuracy (88%-94.6%) in detecting uterine leiomyosarcoma, making radiologists valuable partners to gynecologists in risk assessment and disease management. The algorithm outlined in the Radiology 2023 MRI Evaluation of Uterine Masses for Risk of Leiomyosarcoma consensus statement has been preliminarily validated, and the authors present additional nuances to enhance its application in clinical practice.