Table 2.
Summary of MRI studied.
| MRI | Author | Year | Tumor Type (N) | Controls (N) | Results/Conclusions |
|---|---|---|---|---|---|
| T1 | Tanaka [45] | 2004 | LMS (9)/ SMTUMP (3) |
UM (12) | It was found that 9 of the 12 nonbenign characters had more than 50% of high-intensity areas on T2-weighted images (T2WI), and some hyperintense foci on T1-weighted images (T1WI). |
| Malek [46] | 2019 | USM (21) | UM (84) | Intensity at T1-weighted sequences exhibited no significant difference between USM and UM (p = 0.201). | |
| Ando [47] | 2018 | LMS (14) | LM (1118) | T1 HIA within LM showed more homogeneity, better demarcation, smaller occupying rate, and higher signal intensity than T1 HIA within LMS. | |
| T2 | Sahdev [48] | 2001 | USM (22) | \ | On T2WI, the masses were characteristically of low or intermediate background signal intensity with pockets of very high T2 signal. The areas of high T2 signal corresponded to cystic necrosis in the tumor. |
| Kim [49] | 2018 | ESS (18) LMS (15) | LCD (30) | ESS or LMS more frequently showed high T2 SI compared with LCD (OR = 4.396; p = 0.046). | |
| Malek [46] | 2019 | USM (21) | UM (84) | T2-scaled ratio, tumor myometrium contrast ratio on T2 and tumor myometrium contrast-enhanced ratio achieved a sensitivity of 100% in predicting USM. | |
| Namimoto [53] | 2009 | USM (8) | UM (95) | A combination of ADC and TCR achieved a significant improvement without any overlap between sarcomas and leiomyomas (sensitivity 100%, specificity 100%). | |
| DWI&ADC | Thomassin-Naggara [54] | 2013 | USM (25) | UM (26) | The significant criteria for prediction of malignancy were high DWI signal intensity (OR = +∞), intermediate T2-weighted signal intensity (OR = +∞), mean ADC (OR = 25.1). |
| Li [55] | 2017 | LMS (16) | DLM (26) | The mean ADC value in LMS was significantly lower than that in DLMs (p < 0.001). | |
| Sato [56] | 2014 | LMS (10) | UM (83) | The LMS were readily apparent via DWI, presenting as an intermediate- to high-intensity area in the uterine wall. All low-intensity areas presented as leiomyoma nodules. | |
| Wahab [58] | 2020 | USM (51) | UM (105) | Predictive MRI criteria for malignancy were enlarged lymph nodes or peritoneal implants, high DWI signal greater than that in the endometrium, and ADC less than or equal to 0.905 × 10−3 mm2/s. | |
| CE-MRI | Goto [22] | 2002 | LMS (10) | DLM (130) | The contrast enhancement at 60s after administration of Gd-DTPA was detected in all LMS but absent in 28 of 32 DLM patients. |
| Lin [59] | 2016 | LMS/SMTUMP (8) | UM (25) | For prospective differentiation between uterine LMS/STUMP and benign leiomyoma, CE-MRI can provide accurate information and is preferable to DWI. A combination of DWI and ADC values can achieve comparable diagnostic accuracy to CE-MRI. | |
| Multi-MRI | Lakhman [61] | 2017 | LMS (10) | ALM (14) | Four qualitative MR features most strongly associated with LMS were nodular borders, hemorrhage, “T2 dark” area(s), and central unenhanced area(s). |
| PWI | Malek [63] | 2019 | USM (10) | UM (50) | When 21 features extracted from ROIs were fed into the classifier an accuracy of 91.7%, sensitivity of 100%, and specificity of 90% were achieved in the optimal operating point of the classifier. |
| MRS | Rahimifar [65] | 2019 | USM (21) | UM (84) | The percentage of malignant lesions for which choline and lipid peaks were present was significantly higher than that of benign lesions. By combining the ADC and MRS findings, an accuracy of 98.3 (95.1–100) was achieved. |
| Takeuchi [66] | 2013 | USM (12) | UM (26) | The presence of a high lipid peak for the diagnosis of sarcoma had a sensitivity of 100%, specificity of 96%, positive predictive value of 92% and negative predictive value of 100%. | |
| SWS | Takeuchi [67] | 2019 | USM (10) | UM (24) | The accuracy, sensitivity, and specificity for SWS were 97%, 100%, and 96%, respectively. |
| ESWAN | Tian [69] | 2020 | USM (17) | DLM (33) | The AUC values of phase, R2* and T2* in USM group were 0.854, 0.900 and 0.961, respectively. |
| DKI | Ju [70] | 2021 | USM (13) | DLM (26) | The AUC values of MK, Ka, Kr, FA, MD, Da and Dr were 0.93, 0.99, 0.80, 0.73, 0.94, 0.97 and 0.90. The diagnostic threshold of the parameters were as follows: MK ≥ 0.80, Ka ≥ 0.73, Kr ≥ 0.75, FA ≥ 0.22, MD ≤ 1.47, Da ≤ 1.95, Dr ≤ 1.23. |
LMS: leiomyosarcoma; UM: uterine myoma; USM: uterine sarcoma; DLM: degenerated leiomyoma; SMTUMP: smooth muscle tumors of uncertain malignant potential; ESS: endometrial stromal sarcomas; LCD: Leiomyoma with cystic degeneration; ALM: atypical leiomyoma; T1 HIA: Hyperintense area on T1 weighted images.