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SCIENTIFIC EXHIBIT |
1 From the Departments of Radiology (E.M., E.S.S.), Pathology (L.A.P.J.), and Obstetrics-Gynecology (R.W.T.), University of Pennsylvania Medical Center, First Floor Founders: MRI, 3400 Spruce St, Philadelphia, PA 19104; and the Department of Radiology, Thomas Jefferson University Hospital, Philadelphia (E.K.O.). Presented as a scientific exhibit at the 1998 RSNA scientific assembly. Received January 27, 1999; revision requested March 4 and received April 7; accepted April 12. Address reprint requests to E.S.S.
Leiomyomas are the most common uterine neoplasm and are composed of smooth muscle with varying amounts of fibrous connective tissue. As leiomyomas enlarge, they may outgrow their blood supply, resulting in various types of degeneration: hyaline or myxoid degeneration, calcification, cystic degeneration, and red degeneration. Leiomyomas are classified as submucosal, intramural, or subserosal; the latter may become pedunculated and simulate ovarian neoplasms. Although most leiomyomas are asymptomatic, patients may present with abnormal uterine bleeding, pressure on adjacent organs, pain, infertility, or a palpable abdominal-pelvic mass. Magnetic resonance (MR) imaging is the most accurate imaging technique for detection and localization of leiomyomas. On T2-weighted images, nondegenerated leiomyomas appear as well-circumscribed masses of decreased signal intensity; however, cellular leiomyomas can have relatively higher signal intensity on T2-weighted images and demonstrate enhancement on contrast material–enhanced images. Degenerated leiomyomas have variable appearances on T2-weighted images and contrast-enhanced images. The differential diagnosis of leiomyomas includes adenomyosis, solid adnexal mass, focal myometrial contraction, and uterine leiomyosarcoma. For patients with symptoms, medical or surgical treatment may be indicated. MR imaging also has a role in treatment of leiomyomas by assisting in surgical planning and monitoring the response to medical therapy.
Index Terms: Leiomyoma, 854.315 • Uterine neoplasms, diagnosis, 854.315 • Uterine neoplasms, MR, 854.1214, 854.315 • Uterine neoplasms, therapy, 854.315
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