title: Comparison of the diagnostic accuracy of contrast-enhanced MRI and diffusion-weighted MRI in the differentiation between uterine leiomyosarcoma / smooth muscle tumor with uncertain malignant potential and benign leiomyoma.
abstract: OBJECTIVE
  To compare the diagnostic accuracy of contrast-enhanced (CE) magnetic resonance imaging (MRI) and diffusion-weighted MRI (DWI) in the differentiation between uterine leiomyosarcoma (LMS) / smooth muscle tumor with uncertain malignant potential (STUMP) and benign leiomyoma.
  
  
  METHODS
  A consecutive cohort of 8 LMS/STUMP and 25 benign leiomyomas underwent pelvic MRI exam at 3T. Two radiologists independently evaluated images based on CE-MRI (central nonenhancement at equilibrial phase) and DWI (hyperintensity on b = 1000 s/mm2 and hypointensity on apparent diffusion coefficients [ADC] map). The ADC values were calculated from b = 0 and 1000 s/mm2 .
  
  
  RESULTS
  CE-MRI yielded a significantly superior diagnostic accuracy (0.94 vs. 0.52) and a significantly higher specificity (0.96 vs. 0.36) than DWI (P < 0.05 for both), and remained a comparably high sensitivity as DWI (0.88 vs. 1.00). A combination of DWI and ADC value <1.08 × 10(-3) mm2 /s (determined by receiver operating characteristic analysis) improved diagnostic accuracy, sensitivity, and specificity of DWI to 0.88, 0.88, and 0.88, respectively, by post-hoc analysis based on the same study cohort.
  
  
  CONCLUSIONS
  For prospective differentiation between uterine LMS/STUMP and benign leiomyoma, CE-MRI can provide accurate information and is preferable to DWI. Combination of DWI and ADC values can achieve a comparable diagnostic accuracy to CE-MRI.
authors.affiliation: Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital and Institute for Radiological Research, Chang Gung University, Linkou Medical Center, Guishan, Taoyuan, Taiwan.
authors.forename: Gigin
authors.initials: G
authors.lastname: Lin
authors.affiliation: Clinical Trial Center, Chang Gung Memorial Hospital and Chang Gung University, Linkou Medical Center, Guishan, Taoyuan, Taiwan.
authors.forename: Lan-Yan
authors.initials: LY
authors.lastname: Yang
authors.affiliation: Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital and Institute for Radiological Research, Chang Gung University, Linkou Medical Center, Guishan, Taoyuan, Taiwan.
authors.forename: Yu-Ting
authors.initials: YT
authors.lastname: Huang
authors.affiliation: Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital and Institute for Radiological Research, Chang Gung University, Linkou Medical Center, Guishan, Taoyuan, Taiwan.
authors.forename: Koon-Kwan
authors.initials: KK
authors.lastname: Ng
authors.affiliation: Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital and Institute for Radiological Research, Chang Gung University, Linkou Medical Center, Guishan, Taoyuan, Taiwan.
authors.forename: Shu-Hang
authors.initials: SH
authors.lastname: Ng
authors.affiliation: Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University, Linkou Medical Center, Guishan, Taoyuan, Taiwan.
authors.forename: Shir-Hwa
authors.initials: SH
authors.lastname: Ueng
authors.affiliation: Department of Obstetrics and Gynecology, Gynecology Oncology Research Center, Chang Gung Memorial Hospital and Chang Gung University, Linkou Medical Center, Guishan, Taoyuan, Taiwan.
authors.forename: Angel
authors.initials: A
authors.lastname: Chao
authors.affiliation: Department of Nuclear Medicine and Center for Advanced Molecular Imaging and Translation, Chang Gung Memorial Hospital and Chang Gung University, Linkou Medical Center, Guishan, Taoyuan, Taiwan.
authors.forename: Tzu-Chen
authors.initials: TC
authors.lastname: Yen
authors.affiliation: Department of Obstetrics and Gynecology, Gynecology Oncology Research Center, Chang Gung Memorial Hospital and Chang Gung University, Linkou Medical Center, Guishan, Taoyuan, Taiwan.
authors.forename: Ting-Chang
authors.initials: TC
authors.lastname: Chang
authors.affiliation: Department of Obstetrics and Gynecology, Gynecology Oncology Research Center, Chang Gung Memorial Hospital and Chang Gung University, Linkou Medical Center, Guishan, Taoyuan, Taiwan.
authors.forename: Chyong-Huey
authors.initials: CH
authors.lastname: Lai
mesh_terms: D000328:Adult; D003287:Contrast Media; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D007089:Image Enhancement; D007090:Image Interpretation, Computer-Assisted; D007889:Leiomyoma / Q000473:pathology*; D007890:Leiomyosarcoma / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018235:Smooth Muscle Tumor / Q000473:pathology; D014594:Uterine Neoplasms / Q000473:pathology*
chemical_list: D003287:Contrast Media
keywords: contrast enhancement; diagnostic accuracy; diffusion-weighted imaging; magnetic resonance imaging; uterine sarcoma