Diagnostic value of dual-energy CT and clinicopathological and imaging feature analysis of mixed endometrial stromal and smooth muscle tumors with intracardiac extension

Yi-Yang Liu; Zhan Yu; Rui Wang; Kui-Sheng Chen; Song-Wei Yue; Jun Li; Xue-Mei Gao; Chang-Mao Ding; Zi-Xin Wu; Xi Zhao; Jian-Bo Gao

doi:10.3389/fcvm.2022.917399

Diagnostic value of dual-energy CT and clinicopathological and imaging feature analysis of mixed endometrial stromal and smooth muscle tumors with intracardiac extension

Front Cardiovasc Med. 2022 Sep 15:9:917399. doi: 10.3389/fcvm.2022.917399. eCollection 2022.

Authors

Yi-Yang Liu^{1

2}, Zhan Yu¹, Rui Wang^{1

2}, Kui-Sheng Chen³, Song-Wei Yue¹, Jun Li¹, Xue-Mei Gao⁴, Chang-Mao Ding¹, Zi-Xin Wu⁵, Xi Zhao⁶, Jian-Bo Gao^{1

2}

Affiliations

¹ Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
² Henan Key Laboratory of Imaging Diagnosis and Treatment for Digestive System Tumor, Zhengzhou, China.
³ Department of Pathology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
⁴ Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
⁵ Department of Urology Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
⁶ Department of Customer Services, Siemens Healthineers, Shanghai, China.

Abstract

Objective: To describe the clinicopathological and imaging features of mixed endometrial stromal and smooth muscle tumors with intracardiac extension and to explore the diagnostic value of dual-energy computed tomography (DECT) for this rare entity.

Materials and methods: This retrospective study analyzed the clinicopathological data and images of a 41-year-old female patient with pathologically documented mixed endometrial stromal and smooth muscle tumors with intracardiac extension who had undergone DECT examination. Seven virtual monoenergetic images (VMIs) in 10-kiloelectron volt (keV) intervals (range = 40-100 keV), iodine density (ID) maps, and Z effective (Zeff) maps were reconstructed, and lesion conspicuity was assessed. Tumor homology was analyzed using quantitative DECT parameters and energy spectrum attenuation curve.

Results: The patient complained of a 10-day history of bilateral lower extremity edema. Computed tomography showed a hypoattenuating filling defect located within the paracervical vein that extended into the right atrium to the ventricle through the right iliac veins and inferior vena cava (IVC). Intracardiac and intravenous lesions mainly demonstrated moderate progressive enhancement, with localized non-enhancing necrotic areas on contrast-enhanced CT. Multiple nodules showing progressive enhancement (long-T1 signal, long-T2 signal) were observed at the fundus of the uterus on dynamic contrast-enhanced magnetic resonance imaging (MRI), which were deemed the primary lesions of the tumor. Overall, the tumor was characterized by a small primary lesion with extensive vascular extension. In addition, the 40 keV VMIs reconstructions were found to provide best visualization for the early detection of tumors.

Conclusion: Although a definitive diagnosis of MESSMT with intracardiac extension requires confirmation by histopathological examination, imaging examination can be used to characterize the extent of the lesion. The dual-energy dataset facilitates tumor visualization and homology evaluation.

Keywords: MESSMT; diagnosis; dual-energy CT; intracardiac extension; intravascular extension.