Fibroma MRI: Difference between revisions
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**Soft-tissue component may demonstrate some enhancement | **Soft-tissue component may demonstrate some enhancement | ||
==Uterine Fibromas== | ==Uterine Fibromas== | ||
MRI is not generally required for diagnosis, except for complex or problem-solving cases. It is, however, the most accurate modality for detecting, localizing and characterising fibroids. Size, location and signal intensity should be noted. Signal characteristics are variable and include the following:<ref name="NakaiYamada2017">{{cite journal|last1=Nakai|first1=Go|last2=Yamada|first2=Takashi|last3=Hamada|first3=Takamitsu|last4=Atsukawa|first4=Natsuko|last5=Tanaka|first5=Yoshikazu|last6=Yamamoto|first6=Kiyohito|last7=Higashiyama|first7=Akira|last8=Juri|first8=Hiroshi|last9=Nakamoto|first9=Atsushi|last10=Yamamoto|first10=Kazuhiro|last11=Hirose|first11=Yoshinobu|last12=Ohmichi|first12=Masahide|last13=Narumi|first13=Yoshifumi|title=Pathological findings of uterine tumors preoperatively diagnosed as red degeneration of leiomyoma by MRI|journal=Abdominal Radiology|volume=42|issue=7|year=2017|pages=1825–1831|issn=2366-004X|doi=10.1007/s00261-017-1126-3}}</ref><ref name="MacielTang2017">{{cite journal|last1=Maciel|first1=Cristina|last2=Tang|first2=Yen Zhi|last3=Sahdev|first3=Anju|last4=Madureira|first4=António Miguel|last5=Vilares Morgado|first5=Paulo|title=Preprocedural MRI and MRA in planning fibroid embolization|journal=Diagnostic and Interventional Radiology|volume=23|issue=2|year=2017|pages=163–171|issn=13053825|doi=10.5152/dir.2016.16623}}</ref><ref name="Cassar ScaliaFarulla2018">{{cite journal|last1=Cassar Scalia|first1=Ambra|last2=Farulla|first2=Antonino|last3=Fiocchi|first3=Federica|last4=Alboni|first4=Carlo|last5=Torricelli|first5=Pietro|title=Imaging features of uterine and ovarian fibromatosis in Nevoid Basal Cell Carcinoma Syndrome|journal=Journal of Radiology Case Reports|volume=12|issue=9|year=2018|issn=1943-0922|doi=10.3941/jrcr.v12i9.3390}}</ref><ref name="TakeuchiMatsuzaki2019">{{cite journal|last1=Takeuchi|first1=Mayumi|last2=Matsuzaki|first2=Kenji|last3=Bando|first3=Yoshimi|last4=Harada|first4=Masafumi|title=Evaluation of Red Degeneration of Uterine Leiomyoma with Susceptibility-weighted MR Imaging|journal=Magnetic Resonance in Medical Sciences|volume=18|issue=2|year=2019|pages=158–162|issn=1347-3182|doi=10.2463/mrms.mp.2018-0074}}</ref><ref name="RowlandCall2018">{{cite journal|last1=Rowland|first1=Fauniel|last2=Call|first2=Catherine|last3=Mujtaba|first3=Bilal|last4=Amini|first4=Behrang|last5=Wang|first5=Wei-Lien|title=Calcified leiomyoma of the deltoid: pathophysiology and imaging review|journal=Skeletal Radiology|volume=48|issue=4|year=2018|pages=625–628|issn=0364-2348|doi=10.1007/s00256-018-3053-y}}</ref><ref name="GuptaGupta2018">{{cite journal|last1=Gupta|first1=Avantika|last2=Gupta|first2=Purnima|last3=Manaktala|first3=Usha|title=Varied Clinical Presentations, the Role of Magnetic Resonance Imaging in the Diagnosis, and Successful Management of Cervical Leiomyomas: A Case-Series and Review of Literature|journal=Cureus|year=2018|issn=2168-8184|doi=10.7759/cureus.2653}}</ref> | MRI is not generally required for diagnosis, except for complex or problem-solving cases. It is, however, the most accurate modality for detecting, localizing and characterising fibroids. Size, location and signal intensity should be noted. Signal characteristics are variable and include the following:<ref name="NakaiYamada2017">{{cite journal|last1=Nakai|first1=Go|last2=Yamada|first2=Takashi|last3=Hamada|first3=Takamitsu|last4=Atsukawa|first4=Natsuko|last5=Tanaka|first5=Yoshikazu|last6=Yamamoto|first6=Kiyohito|last7=Higashiyama|first7=Akira|last8=Juri|first8=Hiroshi|last9=Nakamoto|first9=Atsushi|last10=Yamamoto|first10=Kazuhiro|last11=Hirose|first11=Yoshinobu|last12=Ohmichi|first12=Masahide|last13=Narumi|first13=Yoshifumi|title=Pathological findings of uterine tumors preoperatively diagnosed as red degeneration of leiomyoma by MRI|journal=Abdominal Radiology|volume=42|issue=7|year=2017|pages=1825–1831|issn=2366-004X|doi=10.1007/s00261-017-1126-3}}</ref><ref name="MacielTang2017">{{cite journal|last1=Maciel|first1=Cristina|last2=Tang|first2=Yen Zhi|last3=Sahdev|first3=Anju|last4=Madureira|first4=António Miguel|last5=Vilares Morgado|first5=Paulo|title=Preprocedural MRI and MRA in planning fibroid embolization|journal=Diagnostic and Interventional Radiology|volume=23|issue=2|year=2017|pages=163–171|issn=13053825|doi=10.5152/dir.2016.16623}}</ref><ref name="Cassar ScaliaFarulla2018">{{cite journal|last1=Cassar Scalia|first1=Ambra|last2=Farulla|first2=Antonino|last3=Fiocchi|first3=Federica|last4=Alboni|first4=Carlo|last5=Torricelli|first5=Pietro|title=Imaging features of uterine and ovarian fibromatosis in Nevoid Basal Cell Carcinoma Syndrome|journal=Journal of Radiology Case Reports|volume=12|issue=9|year=2018|issn=1943-0922|doi=10.3941/jrcr.v12i9.3390}}</ref><ref name="TakeuchiMatsuzaki2019">{{cite journal|last1=Takeuchi|first1=Mayumi|last2=Matsuzaki|first2=Kenji|last3=Bando|first3=Yoshimi|last4=Harada|first4=Masafumi|title=Evaluation of Red Degeneration of Uterine Leiomyoma with Susceptibility-weighted MR Imaging|journal=Magnetic Resonance in Medical Sciences|volume=18|issue=2|year=2019|pages=158–162|issn=1347-3182|doi=10.2463/mrms.mp.2018-0074}}</ref><ref name="RowlandCall2018">{{cite journal|last1=Rowland|first1=Fauniel|last2=Call|first2=Catherine|last3=Mujtaba|first3=Bilal|last4=Amini|first4=Behrang|last5=Wang|first5=Wei-Lien|title=Calcified leiomyoma of the deltoid: pathophysiology and imaging review|journal=Skeletal Radiology|volume=48|issue=4|year=2018|pages=625–628|issn=0364-2348|doi=10.1007/s00256-018-3053-y}}</ref><ref name="GuptaGupta2018">{{cite journal|last1=Gupta|first1=Avantika|last2=Gupta|first2=Purnima|last3=Manaktala|first3=Usha|title=Varied Clinical Presentations, the Role of Magnetic Resonance Imaging in the Diagnosis, and Successful Management of Cervical Leiomyomas: A Case-Series and Review of Literature|journal=Cureus|year=2018|issn=2168-8184|doi=10.7759/cureus.2653}}</ref><ref name="StoelingaHehenkamp2018">{{cite journal|last1=Stoelinga|first1=Barbara|last2=Hehenkamp|first2=Wouter J.K.|last3=Nieuwenhuis|first3=Lotte L.|last4=Conijn|first4=Mandy M.A.|last5=van Waesberghe|first5=JanHein H.T.M.|last6=Brölmann|first6=Hans A.M.|last7=Huirne|first7=Judith A.F.|title=Accuracy and Reproducibility of Sonoelastography for the Assessment of Fibroids and Adenomyosis, with Magnetic Resonance Imaging as Reference Standard|journal=Ultrasound in Medicine & Biology|volume=44|issue=8|year=2018|pages=1654–1663|issn=03015629|doi=10.1016/j.ultrasmedbio.2018.03.027}}</ref> | ||
*T1 | *T1 | ||
**Non-degenerated fibroids and calcification appear as low to intermediate signal intensity compared with the normal myometrium | **Non-degenerated fibroids and calcification appear as low to intermediate signal intensity compared with the normal myometrium | ||
Revision as of 17:21, 10 June 2019
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Fibroma Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Fibroma MRI On the Web |
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American Roentgen Ray Society Images of Fibroma MRI |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]
Overview
MRI may be helpful in the diagnosis of fibroma. On MRI, fibromas appear isointense or hypointense on T1 sequences and hyperintense on T2 sequences.[1]
MRI Findings
MRI findings of ovarian fibroma include the following:[1]
| MRI component | Features |
|---|---|
|
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|
|
|
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Non-ossifying Fibroma
- MRI appearances of non-ossifying fibroma are variable and depends on when along the development and healing phase the lesion is imaged. Initially, the lesion has high or intermediate T2 signal, with a peripheral low signal rim corresponding to the sclerotic border. As it matures and begins to ossify, the signal becomes low on all sequences.
Contrast enhancement is also variable.[1]
Ossifying Fibroma
MRI findings of ossifying fibroma includes the following:[1]
- T1: low signal
- T2: iso-high signal
- T1 C+ (Gd): typically shows enhancement
Chondromyxoid Fibroma
MRI features of chondromyxoid fibromas are often not particularly specific. Signal characteristics include the following:[1]
- T1: low signal
- T1 C+ (Gd)
- The majority (~70%) tend to show peripheral nodular enhancement
- Approximately 30% have diffuse contrast enhancement and this can be either homogeneous or heterogeneous
- T2: high signal
Desmoplastic Fibroma
There is considerable overlap with other bony lesions on MRI appearances of desmoplastic fibroma. Signal characteristics include the following:[2][3][4][5]
- T1: typically low signal
- T2: has background intermediate to high signal with intrinsic low to intermediate intensity foci within 7
- T1 C+ (Gd): often shows heterogeneous enhancement
Cardiac Fibromas
Because of their dense, fibrous nature, the tumors are usually homogeneous and hypointense on T2-weighted MR images and isointense relative to muscle on T1-weighted images. Cardiac fibroma often demonstrate little or no contrast material enhancement.
Pleural Fibromas
Due to the fibrous component, signal characteristics tend to include the following:
- T1: typically low to intermediate signal
- T2: typically low signal overall (thought to be due to high cellularity and abundant collagen); areas of necrosis and myxoid degeneration can have high signal
- MRI may also show necrotic, haemorrhagic and cystic components in better detail if these entities are present.
Cemento-ossifying Fibroma
Although cemento-ossifying fibroma are composed of a mixture of calcified and noncalcified soft-tissue, as the later is predominantly fibrous, the whole mass is largely of low intensity on MRI.[1]
- T1
- Intermediate to low signal
- Focal regions of higher signal may represent fatty marrow in ossified components
- T2:
- Low signal
- T1 C+ (Gd)
- Soft-tissue component may demonstrate some enhancement
Uterine Fibromas
MRI is not generally required for diagnosis, except for complex or problem-solving cases. It is, however, the most accurate modality for detecting, localizing and characterising fibroids. Size, location and signal intensity should be noted. Signal characteristics are variable and include the following:[6][7][8][9][10][11][12]
- T1
- Non-degenerated fibroids and calcification appear as low to intermediate signal intensity compared with the normal myometrium
- Characteristic high signal intensity on T1 weighted images/an irregular, T1 hyperintense rim around a centrally located myoma suggests red degeneration, which is caused by **Venous thrombosis
- T2
- Non-degenerated fibroids and calcification appear as low signal intensity
- As they are usually hypervascular, flow voids are often observed around them
- Fibroids that have undergone cystic degeneration/necrosis can have a variable appearance, usually appearing high signal on T2 sequences.
- Hyaline degeneration is demonstrated as low T2 signal intensity
- Cystic degeneration, which is an advanced stage of intratumoral edema, also shows high signal intensity on T2 weighted images and does not enhance
- T1 C+ (Gd)
- Variable enhancement is seen with contrast administration
- Marked high signal intensity with gradual enhancement suggests myxoid degeneration
MRI is of significant value in the symptomatic patient when surgery and uterine salvage therapy is considered. It is also of great value in differentiating a pedunculated fibroid from an adnexal mass.
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Fibroma. Radiopedia(2015) http://radiopaedia.org/search?utf8=%E2%9C%93&q=fibroma&scope=all Accessed on March 12, 2016
- ↑ Frick, Matthew A.; Sundaram, Murali; Unni, Krishnan K.; Inwards, Carrie Y.; Fabbri, Nicola; Trentani, Federico; Baccini, Patrizia; Bertoni, Franco (2005). "Imaging Findings in Desmoplastic Fibroma of Bone: Distinctive T2 Characteristics". American Journal of Roentgenology. 184 (6): 1762–1767. doi:10.2214/ajr.184.6.01841762. ISSN 0361-803X.
- ↑ Kim, Ok Hwa; Kim, Seon Jeong; Kim, Ji Yeon; Ryu, Ji Hwa; Choo, Hye Jung; Lee, Sun Joo; Lee, In Sook; Suh, Kyung Jin (2013). "Desmoplastic Fibroma of Bone in a Toe: Radiographic and MRI Findings". Korean Journal of Radiology. 14 (6): 963. doi:10.3348/kjr.2013.14.6.963. ISSN 1229-6929.
- ↑ Shuto, Rieko; Kiyosue, Hiro; Hori, Yuko; Miyake, Hidetoshi; Kawano, Katsunori; Mori, Hiromu (2001). "CT and MR imaging of desmoplastic fibroblastoma". European Radiology. 12 (10): 2474–2476. doi:10.1007/s00330-001-1217-x. ISSN 0938-7994.
- ↑ Gong, Li-Hua; Liu, Wei-Feng; Ding, Yi; Geng, Yue-Hang; Sun, Xiao-Qi; Huang, Xiao-Yuan (2018). "Diagnosis and Differential Diagnosis of Desmoplastic Fibroblastoma by Clinical, Radiological, and Histopathological Analyses". Chinese Medical Journal. 131 (1): 32–36. doi:10.4103/0366-6999.221274. ISSN 0366-6999.
- ↑ Nakai, Go; Yamada, Takashi; Hamada, Takamitsu; Atsukawa, Natsuko; Tanaka, Yoshikazu; Yamamoto, Kiyohito; Higashiyama, Akira; Juri, Hiroshi; Nakamoto, Atsushi; Yamamoto, Kazuhiro; Hirose, Yoshinobu; Ohmichi, Masahide; Narumi, Yoshifumi (2017). "Pathological findings of uterine tumors preoperatively diagnosed as red degeneration of leiomyoma by MRI". Abdominal Radiology. 42 (7): 1825–1831. doi:10.1007/s00261-017-1126-3. ISSN 2366-004X.
- ↑ Maciel, Cristina; Tang, Yen Zhi; Sahdev, Anju; Madureira, António Miguel; Vilares Morgado, Paulo (2017). "Preprocedural MRI and MRA in planning fibroid embolization". Diagnostic and Interventional Radiology. 23 (2): 163–171. doi:10.5152/dir.2016.16623. ISSN 1305-3825.
- ↑ Cassar Scalia, Ambra; Farulla, Antonino; Fiocchi, Federica; Alboni, Carlo; Torricelli, Pietro (2018). "Imaging features of uterine and ovarian fibromatosis in Nevoid Basal Cell Carcinoma Syndrome". Journal of Radiology Case Reports. 12 (9). doi:10.3941/jrcr.v12i9.3390. ISSN 1943-0922.
- ↑ Takeuchi, Mayumi; Matsuzaki, Kenji; Bando, Yoshimi; Harada, Masafumi (2019). "Evaluation of Red Degeneration of Uterine Leiomyoma with Susceptibility-weighted MR Imaging". Magnetic Resonance in Medical Sciences. 18 (2): 158–162. doi:10.2463/mrms.mp.2018-0074. ISSN 1347-3182.
- ↑ Rowland, Fauniel; Call, Catherine; Mujtaba, Bilal; Amini, Behrang; Wang, Wei-Lien (2018). "Calcified leiomyoma of the deltoid: pathophysiology and imaging review". Skeletal Radiology. 48 (4): 625–628. doi:10.1007/s00256-018-3053-y. ISSN 0364-2348.
- ↑ Gupta, Avantika; Gupta, Purnima; Manaktala, Usha (2018). "Varied Clinical Presentations, the Role of Magnetic Resonance Imaging in the Diagnosis, and Successful Management of Cervical Leiomyomas: A Case-Series and Review of Literature". Cureus. doi:10.7759/cureus.2653. ISSN 2168-8184.
- ↑ Stoelinga, Barbara; Hehenkamp, Wouter J.K.; Nieuwenhuis, Lotte L.; Conijn, Mandy M.A.; van Waesberghe, JanHein H.T.M.; Brölmann, Hans A.M.; Huirne, Judith A.F. (2018). "Accuracy and Reproducibility of Sonoelastography for the Assessment of Fibroids and Adenomyosis, with Magnetic Resonance Imaging as Reference Standard". Ultrasound in Medicine & Biology. 44 (8): 1654–1663. doi:10.1016/j.ultrasmedbio.2018.03.027. ISSN 0301-5629.