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Figure 9c. Malignant leiomyosarcoma. (a, b) Pre-UAE single-shot fast SE T2-weighted (4.4/64) (a) and gadolinium-enhanced 3D T1-weighted VIBE (4.5/1.9, 15° flip angle) (b) MR images show a heterogeneous fibroid with degeneration. UAE was technically successful. (c, d) Single-shot fast SE T2-weighted (4.4/64) (c) and gadolinium-enhanced fat-suppressed 3D T1-weighted VIBE (4.5/1.9, 15° flip angle) (d) MR images obtained 4 months later show growing residual viable tissue. (e, f ) MR images (same parameters as c and d) obtained 11 months after UAE and recurrent symptoms show rapid regrowth of the fibroid. A diagnosis of malignant transformation was considered. (g) CT scan obtained 2 years after UAE shows multiple lung nodules, which were presumed to be metastases. Although rare, malignant transformation can occur and underscores the need for careful clinical and imaging follow-up.
