Share：
Share this content in WeChat
X
[Chinese][PDF]4925
• Clinical Article •
Application of T2WI, DWI sequence combined with serum CA125 in the differential diagnosis of uterine sarcoma and atypical leiomyoma
PAN Yuanrui  LIU Yang  TANG Mingmei  LIU Hui  ZHANG Ke  LÜ Fajin 

Cite this article as: PAN Y R, LIU Y, TANG M M, et al. Application of T2WI, DWI sequence combined with serum CA125 in the differential diagnosis of uterine sarcoma and atypical leiomyoma[J]. Chin J Magn Reson Imaging, 2023, 14(12): 60-65. DOI:10.12015/issn.1674-8034.2023.12.010.


[Abstract] Objective To explore the value of T2-weighted imaging (T2WI), diffusion weighted imaging (DWI) and mean apparent diffusion coefficient (mADC) combined with cancer antigen 125 (CA125) in the differential diagnosis of uterine sarcoma and atypical leiomyoma.Materials and Methods From January 2011 to February 2023, 59 patients with uterine sarcoma and 118 patients with atypical leiomyomas confirmed by pathology in our hospital were retrospectively analyzed. The imaging features of T2WI and DWI (including signal intensity of T2WI and DWI, maximum tumor diameter, mADC value) and clinical relevant information (including age, clinical symptoms, menopausal status and serum CA125) were collected. Mann-Whitney U test and chi-square test were used for univariate analysis, and then logistic regression was used to construct models based on T2WI, DWI sequence and serum CA125 alone or in combination. The receiver operating characteristic (ROC) curve was used to evaluate the performance of the prediction model, and the area under the curve (AUC), sensitivity and specificity of the model were calculated.Results The preoperative serum CA125 levels in the uterine sarcoma group were significantly higher than those in the atypical leiomyoma group (P=0.043). On T2WI and DWI sequences, the solid component of uterine sarcoma showed more hyperintensity than that of atypical leiomyoma, and the mADC value was significantly lower than that of atypical leiomyoma (all P＜0.001). The optimal preoperative cut-off value for serum CA125 used to identify the two was 23.41 U/mL, and the optimal cut-off value for mADC was 1.165×10-3 mm2/s. The combination of T2WI, DWI, mADC values and serum CA125 resulted in an AUC of 0.981, a sensitivity of 98.3% and a specificity of 92.4% (P＜0.001).Conclusions T2WI and DWI sequences combined with serum CA125 can be used as an effective method to distinguish uterine sarcoma from atypical leiomyoma.
[Keywords] uterine sarcoma；atypical leiomyoma；T2-weighted imaging；diffusion weighted imaging；apparent diffusion coefficient；magnetic resonance imaging；cancer antigen 125

PAN Yuanrui1, 2   LIU Yang3   TANG Mingmei1, 2   LIU Hui1, 2   ZHANG Ke1, 2   LÜ Fajin1, 2, 3*  

1 State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing 400016, China

2 Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing 400016, China

3 Department of Radiology, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China

Corresponding author: LÜ F J, E-mail: fajinlv@163.com

Conflicts of interest   None.

ACKNOWLEDGMENTS Foundation of State Key Laboratory of Ultrasound in Medicine and Engineering (No. 2022KFKT005).
Received  2023-09-19
Accepted  2023-12-08
DOI: 10.12015/issn.1674-8034.2023.12.010
Cite this article as: PAN Y R, LIU Y, TANG M M, et al. Application of T2WI, DWI sequence combined with serum CA125 in the differential diagnosis of uterine sarcoma and atypical leiomyoma[J]. Chin J Magn Reson Imaging, 2023, 14(12): 60-65. DOI:10.12015/issn.1674-8034.2023.12.010.

[1]
DEMULDER D, ASCHER S M. Uterine leiomyosarcoma: can MRI differentiate leiomyosarcoma from benign leiomyoma before treatment?[J]. AJR Am J Roentgenol, 2018, 211(6): 1405-1415. DOI: 10.2214/AJR.17.19234.
[2]
BI Q, XIAO Z B, LV F J, et al. Utility of clinical parameters and multiparametric MRI as predictive factors for differentiating uterine sarcoma from atypical leiomyoma[J]. Acad Radiol, 2018, 25(8): 993-1002. DOI: 10.1016/j.acra.2018.01.002.
[3]
GLORIE N, BAERT T, VAN DEN BOSCH T, et al. Circulating protein biomarkers to differentiate uterine sarcomas from leiomyomas[J]. Anticancer Res, 2019, 39(8): 3981-3989. DOI: 10.21873/anticanres.13553.
[4]
GIULIANI E, AS-SANIE S, MARSH E E. Epidemiology and management of uterine fibroids[J]. Int J Gynaecol Obstet, 2020, 149(1): 3-9. DOI: 10.1002/ijgo.13102.
[5]
LIN Y, WU R C, HUANG Y L, et al. Uterine fibroid-like tumors: spectrum of MR imaging findings and their differential diagnosis[J]. Abdom Radiol, 2022, 47(6): 2197-2208. DOI: 10.1007/s00261-022-03431-6.
[6]
MAHMOOD N S, RASHID A A AL, LADUMOR S B, et al. The role of multiparametric MRI in differentiating uterine leiomyosarcoma from benign degenerative leiomyoma and leiomyoma variants: a retrospective analysis[J]. Clin Radiol, 2023, 78(1): 47-54. DOI: 10.1016/j.crad.2022.08.144.
[7]
AMINZADEH P, ALIBRAHIM E, DOBROTWIR A, et al. Multiparametric MR evaluation of uterine leiomyosarcoma and STUMP versus leiomyoma in symptomatic women planned for high frequency focussed ultrasound: accuracy of imaging parameters and interobserver agreement for identification of malignancy[J/OL]. Br J Radiol, 2021, 94(1119): 20200483 [2023-11-14]. https://pubmed.ncbi.nlm.nih.gov/33507806/. DOI: 10.1259/bjr.20200483.
[8]
SHI Z, JIANG J M, OUYANG H, et al. With 3 types of respiratory acquisition: 3.0 T respiratory triggered acquisition can obtain higher quality DWI images of the upper abdomen[J/OL]. Contrast Media Mol Imaging, 2022, 2022: 9579145 [2023-09-23]. https://pubmed.ncbi.nlm.nih.gov/35854769/. DOI: 10.1155/2022/9579145.
[9]
ZAPARDIEL I, BORIA F, HALASKA M J, et al. Laparoscopic power morcellation: techniques to avoid tumoral spread[J]. J Minim Invasive Gynecol, 2021, 28(8): 1442-1443. DOI: 10.1016/j.jmig.2020.09.012.
[10]
MALEK M, RAHMANI M, SEYYED EBRAHIMI S M, et al. Investigating the diagnostic value of quantitative parameters based on T2-weighted and contrast-enhanced MRI with psoas muscle and outer myometrium as internal references for differentiating uterine sarcomas from leiomyomas at 3T MRI[J/OL]. Cancer Imaging, 2019, 19(1): 20 [2023-11-14]. https://pubmed.ncbi.nlm.nih.gov/30935419/. DOI: 10.1186/s40644-019-0206-8.
[11]
NAMIMOTO T, YAMASHITA Y, AWAI, et al. Combined use of T2-weighted and diffusion-weighted 3-T MR imaging for differentiating uterine sarcomas from benign leiomyomas[J]. Eur Radiol, 2009, 19(11): 2756-2764. DOI: 10.1007/s00330-009-1471-x.
[12]
LONG X W, ZHUANG W X, HUANG W F, et al. The application value of MR diffusion weighted imaging in the diagnosis of uterine fibroids and uterine sarcoma[J]. J Mod Oncol, 2017, 25(24): 4046-4049. DOI: 10.3969/j.issn.1672-4992.2017.24.032.
[13]
ABDEL W C, JANNOT A S, BONAFFINI P A, et al. Diagnostic algorithm to differentiate benign atypical leiomyomas from malignant uterine sarcomas with diffusion-weighted MRI[J]. Radiology, 2020, 297(2):361-371. DOI: 10.1148/radiol.2020191658.
[14]
WANG N, LI C P, YANG Y J, et al. The use of platelet/lymphocyte ratio and cancer antigen 125 combined with magnetic resonance diffusion-weighted imaging in diagnosis of recurrent ovarian cancer and neuropathic pain[J]. World Neurosurg, 2021, 149: 502-510. DOI: 10.1016/j.wneu.2020.11.117.
[15]
ZHOU H, CHEN Y, WANG J F, et al. Diagnostic value of preoperative peripheral blood markers in uterine sarcomas[J]. Anhui Med J, 2020, 41(7): 751-754. DOI: 10.3969/j.issn.1000-0399.2020.07.004.
[16]
YAN Y J, YU W Y, LEI W Y. Analysis of the value of serum CA125 and LDH in women with uterine sarcoma[J]. Chin J Woman Child Heath Res, 2019, 30(8): 1022-1025. DOI: 10.3969/j.issn.1673-5293.2019.08.027.
[17]
POTIKUL C, TANGJITGAMOL S, KHUNNARONG J, et al. Uterine sarcoma: clinical presentation, treatment and survival outcomes in Thailand[J]. Asian Pac J Cancer Prev, 2016, 17(4): 1759-1767. DOI: 10.7314/apjcp.2016.17.4.1759.
[18]
LASMAR R B, LASMAR B P. The role of leiomyomas in the genesis of abnormal uterine bleeding (AUB)[J]. Best Pract Res Clin Obstet Gynaecol, 2017, 40: 82-88. DOI: 10.1016/j.bpobgyn.2016.09.008.
[19]
ZHANG G R, YU X, ZHU L, et al. Preoperative clinical characteristics scoring system for differentiating uterine leiomyosarcoma from fibroid[J/OL]. BMC Cancer, 2020, 20(1): 514 [2023-11-14]. https://pubmed.ncbi.nlm.nih.gov/32493236/. DOI: 10.1186/s12885-020-07003-z.
[20]
YE D, YUAN L, YAO L Q. The analysis of the prognositic factors between uterine sarcoma and carcinosarcoma[J]. J Int Obstet Gynecol, 2016, 43(3): 353-356.
[21]
SONG Y, LIU A J. Interpretation of the classification of female reproductive organ tumors in the fifth edition of WHO[J]. Chin J Diagn Pathol, 2021, 28(1): 1-4. DOI: 10.3969/j.issn.1007-8096.2021.01.001.
[22]
HUANG X L, WANG Y L, HE X Q, et al. Comparison between serum HE4 and CA125 as tumor markers in premenopausal women with benign pelvic mass[J/OL]. Clin Lab, 2019, 65(5) [2023-11-14]. https://pubmed.ncbi.nlm.nih.gov/31115211/. DOI: 10.7754/Clin.Lab.2018.180913.
[23]
ZHANG F F, LIU Y, QUAN Q, et al. Diagnostic value of preoperative CA125, LDH and HE4 for leiomyosarcoma of the female reproductive system[J]. Cancer Manag Res, 2021, 13: 4657-4664. DOI: 10.2147/CMAR.S302223.
[24]
SKORSTAD M, KENT A, LIENG M. Preoperative evaluation in women with uterine leiomyosarcoma. A nationwide cohort study[J]. Acta Obstet Gynecol Scand, 2016, 95(11): 1228-1234. DOI: 10.1111/aogs.13008.
[25]
KIM T H, KIM J W, KIM S Y, et al. What MRI features suspect malignant pure mesenchymal uterine tumors rather than uterine leiomyoma with cystic degeneration?[J/OL]. J Gynecol Oncol, 2018, 29(3): e26 [2023-11-14]. https://pubmed.ncbi.nlm.nih.gov/29400019/. DOI: 10.3802/jgo.2018.29.e26.
[26]
WANG Q, WU X Y, ZHU X G, et al. MRI features and clinical outcomes of unexpected uterine sarcomas in patients who underwent high-intensity focused ultrasound ablation for presumed uterine fibroids[J]. Int J Hyperthermia, 2021, 38(2): 39-45. DOI: 10.1080/02656736.2021.1921288.
[27]
XUE K K, CHENG J L, BAI J, et al. Value of DWI and dynamic contrast-enhanced MRI in differentially diagnosing uterine sarcomas and degenerated leiomyomas[J]. Chin J Med Imag Technol, 2016, 32(2): 274-278. DOI: 10.13929/J.1003-3289.2016.02.028.
[28]
BI Q, LÜ F J, XIAO Z B, et al. Using multiparametric MRI to differentiate uterine leiomyosarcoma from atypical leiomyoma[J]. Chin J Magn Reson Imag, 2018, 9(2): 108-112. DOI: 10.12015/issn.1674-8034.2018.02.006.
[29]
WANG C, ZHENG X Y, ZHOU Z F, et al. Differentiating cellular leiomyoma from uterine sarcoma and atypical leiomyoma using multi-parametric MRI[J/OL]. Front Oncol, 2022, 12: 1005191 [2023-09-23]. https://pubmed.ncbi.nlm.nih.gov/36276145/. DOI: 10.3389/fonc.2022.1005191.
[30]
SUZUKI A, KIDO A, MATSUKI M, et al. Development of an algorithm to differentiate uterine sarcoma from fibroids using MRI and LDH levels[J/OL]. Diagnostics, 2023, 13(8): 1404 [2023-09-23]. https://pubmed.ncbi.nlm.nih.gov/37189505/. DOI: 10.3390/diagnostics13081404.
[31]
ROSA F, MARTINETTI C, MAGNALDI S, et al. Uterine mesenchymal tumors: development and preliminary results of a magnetic resonance imaging (MRI) diagnostic algorithm[J]. Radiol Med, 2023, 128(7): 853-868. DOI: 10.1007/s11547-023-01654-1.
[32]
VALLETTA R, CORATO V, LOMBARDO F, et al. Leiomyoma or sarcoma? MRI performance in the differential diagnosis of sonographically suspicious uterine masses[J/OL]. Eur J Radiol, 2023, 170: 111217 [2023-12-04]. https://pubmed.ncbi.nlm.nih.gov/38042020/. DOI: 10.1016/j.ejrad.2023.111217.
[33]
RIO G, LIMA M, GIL R, et al. T2 hyperintense myometrial tumors: can MRI features differentiate leiomyomas from leiomyosarcomas?[J]. Abdom Radiol, 2019, 44(10): 3388-3397. DOI: 10.1007/s00261-019-02097-x.
[34]
TOYOHARA Y, SONE K, NODA K, et al. Development of a deep learning method for improving diagnostic accuracy for uterine sarcoma cases[J/OL]. Sci Rep, 2022, 12(1): 19612 [2023-12-04]. https://pubmed.ncbi.nlm.nih.gov/36385486/. DOI: 10.1038/s41598-022-23064-5.
[35]
HIMOTO Y, KIDO A, SAKATA A, et al. Differentiation of uterine low-grade endometrial stromal sarcoma from rare leiomyoma variants by magnetic resonance imaging[J/OL]. Sci Rep, 2021, 11(1): 19124 [2023-12-04]. https://pubmed.ncbi.nlm.nih.gov/34580348/. DOI: 10.1038/s41598-021-98473-z.
[36]
KUMAGAI K, YAGI T, YAMAZAKI M, et al. Quantitative MR texture analysis for the differentiation of uterine smooth muscle tumors with high signal intensity on T2-weighted imaging[J/OL]. Medicine, 2023, 102(31): e34452 [2023-12-04]. https://pubmed.ncbi.nlm.nih.gov/37543807/. DOI: 10.1097/MD.0000000000034452.

PREV Predictive value of positive margins after radical prostatectomy for prostate cancer based on Bp-MRI radiomics
NEXT Evaluation of DWI on the early therapeutic efficacy of HIFU in adenomyosis
  


LINK


Tel & Fax: +8610-67113815    E-mail: editor@cjmri.cn