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Value of R2* and T2* in differential diagnosis of uterine sarcoma and degenerated hysteromyoma
Miao Niu1, Ailian Liu1, and Lizhi Xie2

1The First Affiliated Hospital of Dalian Medical University, DaLian, China, 2GE Healthcare, MR Research, Beijing, China

Synopsis

To investigate the clinical value of enhanced T2 star weighted angiography (ESWAN) quantitative parameters in differential diagnosis of uterine sarcoma and degenerated hysteromyoma.

Purpose

To investigate the clinical value of enhanced T2 star weighted angiography (ESWAN) quantitative parameters in differential diagnosis of uterine sarcoma and degenerated hysteromyoma.

Method and Materials

Fourteen cases of uterine sarcoma(US) and twenty-nine cases of histopathology confirmed degenerated hysteromyoma (DH) including hyaline degeneration and mucinous degeneration from September 2008 to February 2017 in our hospital were retrospectively analyzed. The age of patients ranged from 48 to 85 years. All patients underwent 1.5T (GE 1.5T Signa HDXT, America) MRI exams including conventional T1WI, T2WI, LAVA and ESWAN. The ESWANI images were post-processed using FuncTool software on AW4.6 workstation, and R2* and T2* maps were obtained. Two region of interest (ROI) were placed on the R2* map and T2* map of US and DH respectively, and ROI was larger than the lesions of 1/3(Figure1-2). The images were analyzed and measured by two radiologists using in a double-blind fashion. The measured R2* value and T2* values were tested by intra-class correlation coefficient (ICC). If the high consistency was obtained, the average value was used in further statistical analysis. The differences of R2* value and T2* value between US and DH were compared by nonparametric-test retrospectively(Table1). The ROC curves of all parameters were used to assess the diagnostic value of ESWAN in differentiating US and DH(Figure3).

Result

The parameters measured by the two observers agreed with each other well(ICC>0.75). The R2* value of US was statistically lower than that of DH6.45（2.71，12.64）vs 15.20（13.08，17.03）, p=0.000. The T2* value of US was statistically higher than DH 179.71（87.03，221.65）vs 6.37（59.51,81.60）, P=0.000. The area under the ROC curve(AUC) of R2* and T2* was 0.928,0.862 respectively. The threshold of R2* and T2* for differentiating US from DH was ≥12.70、≤93.59 respectively and the sensitivity, specificity were 89.7%，84.5%、93.1%，76.9% respectively(Table2).

Conclusion and Discussion

The R2* and T2* from ESWAN can effectively identify US and DH which can be a good choose to guide clinical treatment and assess prognosis. Uterine sarcoma (US) and degenerated hysteromyoma (DH) are two kinds of tumors of the female reproductive system, but prognosis is completely different. During to the similarity in images, they often misdiagnosed. So it is very important to distinguish them.

Acknowledgements

No acknowledgement found.

References

[1] DeMulder D, Ascher SM. Uterine Leiomyosarcoma: Can MRI Differentiate Leiomyosarcoma From Benign Leiomyoma Before Treatment? AJR Am J Roentgenol. 2018 Oct 24:1-11.
[2] Takeuchi M, Matsuzaki K, Harada M. Clinical utility of susceptibility-weighted MR sequence for the evaluation of uterine sarcomas. Clin Imaging. 2018 Oct 13;53:143-150.

Figures

Figure.1（①-③）US ①ESWAN image ②R2* reconstruction image (ROI placed in the center of the lesion, to avoid cystic degeneration, necrosis, bleeding, get R2* value) ③T2* reconstruction image (ROI placed in the center of the lesion, to avoid cystic degeneration, necrosis, bleeding, get T2* value).

Figure.2（④-⑥）DH ④ESWAN image ⑤R2* reconstruction image (ROI placed in the center of the lesion, to avoid cystic degeneration, necrosis, bleeding, get R2* value) ③T2* reconstruction image (ROI placed in the center of the lesion, to avoid cystic degeneration, necrosis, bleeding, get T2* value)

Figure.3 R2 * and T2 * values to diagnose the ROC curves for US and DH.

Table.1 Comparison of the R2 * and T2 * values between US and DH.

Table.2 The AUC, threshold, sensitivity, and specificity of the R2 * and T2 * values of US and DH.

Proc. Intl. Soc. Mag. Reson. Med. 27 (2019)
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