{"title":"Differentiating uterine adenosarcoma from endometrial polyps: MRI imaging features.","authors":"Kumi Harada, Yasuhisa Kurata, Yuki Himoto, Aki Kido, Mitsuhiro Kirita, Atsushi Yoshida, Yuka Kuriyama Matsumoto, Junzo Hamanishi, Sachiko Minamiguchi, Hiroaki Ito, Akitoshi Nakashima, Takashi Minamisaka, Sayaka Daido, Kaoru Abiko, Koki Moriyoshi, Kumiko Ando, Shigeki Arizono, Takuya Aoki, Shigeo Hara, Masaki Mandai, Yuji Nakamoto","doi":"10.1007/s00261-025-04905-z","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>This study was conducted to identify MRI features distinguishing uterine adenosarcoma from endometrial polyps and to predict the presence or absence of sarcomatous overgrowth (SO), a pathological finding linked to poor prognosis.</p><p><strong>Methods: </strong>This multicenter retrospective study included 11 cases of uterine adenosarcoma, with 5 showing SO and 6 without, and 20 cases of endometrial polyps measuring 3 cm or greater diameter. Quantitative evaluations (tumor volume, cystic lesion size, diffusion-weighted imaging [DWI] signal ratio, apparent diffusion coefficient [ADC] value, and normalized ADC value) and qualitative evaluations (degree of hemorrhage, signal intensity on T2-weighted imaging and DWI, number of cystic lesions, degree of contrast enhancement, and tumor localization) were performed. The evaluation parameters were compared between uterine adenosarcoma and endometrial polyp groups, and between SO and non-SO subgroups within uterine adenosarcoma.</p><p><strong>Results: </strong>Uterine adenosarcoma had significantly larger tumor volumes (median 192,324 mm³ vs. 15,717 mm³, p < 0.001), larger cystic lesions (median 17.7 mm vs. 6.7 mm, p = 0.0074), and higher DWI signal ratios (median 1.50 vs. 1.08, p = 0.008) along with significantly lower ADC values (median 961.5 × 10<sup>- 6</sup> mm²/s vs. 1222.3 × 10<sup>- 6</sup> mm²/s, p = 0.048) and normalized ADC values (median 0.34 vs. 0.49, p = 0.001) compared to endometrial polyps. Gross hemorrhage (9/11 vs. 1/20, p < 0.001) and high signal intensity on DWI (10/11 vs. 4/20, p < 0.001) were observed more frequently with uterine adenosarcomas. No significant difference was found between uterine adenosarcomas with SO and without SO for any quantitative or qualitative evaluation parameter.</p><p><strong>Conclusions: </strong>This study identified key imaging features of uterine adenosarcoma, including larger tumor volume, larger cystic lesions, gross intratumoral hemorrhage, higher DWI signal intensity, and lower ADC values. These findings can facilitate preoperative differentiation of uterine adenosarcoma from endometrial polyps.</p>","PeriodicalId":7126,"journal":{"name":"Abdominal Radiology","volume":" ","pages":""},"PeriodicalIF":2.2000,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Abdominal Radiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00261-025-04905-z","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING","Score":null,"Total":0}
引用次数: 0
Abstract
Objective: This study was conducted to identify MRI features distinguishing uterine adenosarcoma from endometrial polyps and to predict the presence or absence of sarcomatous overgrowth (SO), a pathological finding linked to poor prognosis.
Methods: This multicenter retrospective study included 11 cases of uterine adenosarcoma, with 5 showing SO and 6 without, and 20 cases of endometrial polyps measuring 3 cm or greater diameter. Quantitative evaluations (tumor volume, cystic lesion size, diffusion-weighted imaging [DWI] signal ratio, apparent diffusion coefficient [ADC] value, and normalized ADC value) and qualitative evaluations (degree of hemorrhage, signal intensity on T2-weighted imaging and DWI, number of cystic lesions, degree of contrast enhancement, and tumor localization) were performed. The evaluation parameters were compared between uterine adenosarcoma and endometrial polyp groups, and between SO and non-SO subgroups within uterine adenosarcoma.
Results: Uterine adenosarcoma had significantly larger tumor volumes (median 192,324 mm³ vs. 15,717 mm³, p < 0.001), larger cystic lesions (median 17.7 mm vs. 6.7 mm, p = 0.0074), and higher DWI signal ratios (median 1.50 vs. 1.08, p = 0.008) along with significantly lower ADC values (median 961.5 × 10- 6 mm²/s vs. 1222.3 × 10- 6 mm²/s, p = 0.048) and normalized ADC values (median 0.34 vs. 0.49, p = 0.001) compared to endometrial polyps. Gross hemorrhage (9/11 vs. 1/20, p < 0.001) and high signal intensity on DWI (10/11 vs. 4/20, p < 0.001) were observed more frequently with uterine adenosarcomas. No significant difference was found between uterine adenosarcomas with SO and without SO for any quantitative or qualitative evaluation parameter.
Conclusions: This study identified key imaging features of uterine adenosarcoma, including larger tumor volume, larger cystic lesions, gross intratumoral hemorrhage, higher DWI signal intensity, and lower ADC values. These findings can facilitate preoperative differentiation of uterine adenosarcoma from endometrial polyps.
期刊介绍:
Abdominal Radiology seeks to meet the professional needs of the abdominal radiologist by publishing clinically pertinent original, review and practice related articles on the gastrointestinal and genitourinary tracts and abdominal interventional and radiologic procedures. Case reports are generally not accepted unless they are the first report of a new disease or condition, or part of a special solicited section.
Reasons to Publish Your Article in Abdominal Radiology:
· Official journal of the Society of Abdominal Radiology (SAR)
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European Society of Gastrointestinal and Abdominal Radiology (ESGAR)
European Society of Urogenital Radiology (ESUR)
Asian Society of Abdominal Radiology (ASAR)
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