Uterine Leiomyosarcoma: Can MRI Differentiate Leiomyosarcoma From Benign Leiomyoma Before Treatment?

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Abstract
OBJECTIVE. The purpose of this article is to provide background on the epidemiologic, clinical, and economic impact of uterine leiomyomas, summarize the concerns associated with treating women with potential occult leiomyosarcomas (LMSs), and review the known and emerging imaging features of typical and atypical leiomyomas and explain how to differentiate them from LMSs. CONCLUSION. Surgical management of presumed benign uterine leiomyomas received popular media attention when a case of disseminated LMS occurred after laparoscopic power morcellator–assisted hysterectomy. A subsequent U.S. Food and Drug Administration review found a higher prevalence of unsuspected uterine sarcoma and LMS among patients undergoing myomectomy or hysterectomy for presumed benign leiomyomas than was previously reported. This heightened concern has led to increased pressure on radiologists to distinguish LMSs from leiomyomas.