Development of an Algorithm to Differentiate Uterine Sarcoma from Fibroids Using MRI and LDH Levels

Ayako Suzuki; Aki Kido; Mitsuru Matsuki; Yasushi Kotani; Kosuke Murakami; Yukio Yamanishi; Isao Numoto; Hidekatsu Nakai; Tomoyuki Otani; Ikuo Konishi; Masaki Mandai; Noriomi Matsumura

doi:10.3390/diagnostics13081404

Development of an Algorithm to Differentiate Uterine Sarcoma from Fibroids Using MRI and LDH Levels

Diagnostics (Basel). 2023 Apr 12;13(8):1404. doi: 10.3390/diagnostics13081404.

Authors

Affiliations

¹ Department of Obstetrics and Gynecology, Faculty of Medicine, Kindai University, Osakasayama 589-8511, Japan.
² Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University, Kyoto 606-8507, Japan.
³ Department of Radiology, Faculty of Medicine, Kindai University, Osakasayama 589-8511, Japan.
⁴ Department of Obstetrics and Gynecology, Japanese Red Cross Wakayama Medical Center, Wakayama 640-8558, Japan.
⁵ Department of Gynecology and Obstetrics, Kyoto University, Kyoto 606-8507, Japan.

Abstract

Background: This study aimed to establish an evaluation method for detecting uterine sarcoma with 100% sensitivity using MRI and serum LDH levels.

Methods: One evaluator reviewed the MRI images and LDH values of a total of 1801 cases, including 36 cases of uterine sarcoma and 1765 cases of uterine fibroids. The reproducibility of the algorithm was also examined by four evaluators with different imaging experience and abilities, using a test set of 61 cases, including 14 cases of uterine sarcoma.

Results: From the MRI images and LDH values of 1801 cases of uterine sarcoma and uterine fibroids, we found that all sarcomas were included in the group with a high T2WI and either a high T1WI, an unclear margin, or high LDH values. In addition, when cases with DWI were examined, all sarcomas had high DWI. Among the 36 sarcoma cases, the group with positive findings for T2WI, T1WI, margins, and serum LDH levels all had a poor prognosis (p = 0.015). The reproducibility of the algorithm was examined by four evaluators and the sensitivity of sarcoma detection ranged from 71% to 93%.

Conclusion: We established an algorithm to distinguish uterine sarcoma if tumors in the myometrium with low T2WI and DWI are present.

Keywords: LDH; MRI; morcellator; myomectomy; uterine fibroid; uterine sarcoma.

Grants and funding

This research received no external funding.