{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T18:42:40Z","timestamp":1787769760249,"version":"build-2784847793"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2021,11,9]],"date-time":"2021-11-09T00:00:00Z","timestamp":1636416000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,11,9]],"date-time":"2021-11-09T00:00:00Z","timestamp":1636416000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Jpn J Radiol"],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p>To generate a new discrimination method to distinguish between malignant mesenchymal tumors of the uterus and T2-weighted hyperintense leiomyoma based on magnetic resonance imaging findings and clinical features.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Materials and methods<\/jats:title>\n                <jats:p>Data from 32 tumors of 32 patients with malignant mesenchymal tumors of the uterus and from 34 tumors of 30 patients with T2-weighted hyperintense leiomyoma were analyzed. Clinical parameters, qualitative magnetic resonance imaging features, including computed diffusion-weighted imaging, and quantitative characteristics of magnetic resonance imaging of these two tumor types were compared. Predictive values for malignant mesenchymal tumors of the uterus were calculated using variant discriminant analysis.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The T1 bright area on qualitative assessment and mean apparent diffusion coefficient value on quantitative assessment yielded the most independent magnetic resonance imaging differentiators of malignant mesenchymal tumors of the uterus and T2-weighted hyperintense leiomyoma. The classification accuracy of the variant discriminant analysis based on three selected findings, i.e., a T1 bright area, computed diffusion-weighted imaging with a b-value of 2000s\/mm<jats:sup>2<\/jats:sup> (cDWI<jats:sub>2000<\/jats:sub>), and T2-hypointense bands, was 84.8% (56\/66), indicating high accuracy.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Variant discriminant analysis using the T1 bright area, cDWI<jats:sub>2000<\/jats:sub>, and T2-hypointense bands yielded high accuracy for differentiating between malignant mesenchymal tumors of the uterus and T2-weighted hyperintense leiomyoma.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s11604-021-01217-2","type":"journal-article","created":{"date-parts":[[2021,11,9]],"date-time":"2021-11-09T03:02:31Z","timestamp":1636426951000},"page":"385-395","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Utility of magnetic resonance imaging for differentiating malignant mesenchymal tumors of the uterus from T2-weighted hyperintense leiomyomas"],"prefix":"10.1007","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3559-4550","authenticated-orcid":false,"given":"Koichiro","family":"Matsuura","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaiji","family":"Inoue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eri","family":"Hoshino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masanori","family":"Yasuda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kosei","family":"Hasegawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshitaka","family":"Okada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasutaka","family":"Baba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eito","family":"Kozawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,11,9]]},"reference":[{"key":"1217_CR1","unstructured":"Kim K-R, Lax SF, Lazar AJ, Longacre TA, Malpica A, Matias-Guiu X, et al. 6 Tumours of the uterine corpus. In: Cox J, editors. WHO classification of tumours. 5th ed. Female genital tumours. Lyon: International Agency for Research on Cancer; 2020. pp. 6, 272\u201393."},{"key":"1217_CR2","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1016\/j.ygyno.2009.09.023","volume":"116","author":"E D'Angelo","year":"2010","unstructured":"D\u2019Angelo E, Prat J. Uterine sarcomas: a review. Gynecol Oncol. 2010;116:131\u20139.","journal-title":"Gynecol Oncol"},{"issue":"1","key":"1217_CR3","doi-asserted-by":"publisher","first-page":"18","DOI":"10.3348\/kjr.2018.0090","volume":"20","author":"YT Huang","year":"2019","unstructured":"Huang YT, Huang YL, Ng KK, Lin G. Current status of magnetic resonance imaging in patients with malignant uterine neoplasms: a review. Korean J Radiol. 2019;20(1):18\u201333.","journal-title":"Korean J Radiol"},{"key":"1217_CR4","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1016\/j.ijgo.2015.01.009","volume":"130","author":"J Zhang","year":"2015","unstructured":"Zhang J, Zhang J, Dai Y, Zhu L, Lang J, Leng J. Clinical characteristics and management experience of unexpected uterine sarcoma after myomectomy. Int J Gynaecol Obstet. 2015;130:195\u20139.","journal-title":"Int J Gynaecol Obstet"},{"key":"1217_CR5","doi-asserted-by":"publisher","first-page":"546","DOI":"10.1002\/msj.20145","volume":"76","author":"K Stein","year":"2009","unstructured":"Stein K, Ascher-Walsh C. A comprehensive approach to the treatment of uterine leiomyomata. Mt Sinai J Med. 2009;76:546\u201356.","journal-title":"Mt Sinai J Med"},{"key":"1217_CR6","doi-asserted-by":"publisher","first-page":"895","DOI":"10.1634\/theoncologist.11-8-895","volume":"11","author":"AC Schlaerth","year":"2006","unstructured":"Schlaerth AC, Abu-Rustum NR. Role of minimally invasive surgery in gynecologic cancers. Oncologist. 2006;11:895\u2013901.","journal-title":"Oncologist"},{"key":"1217_CR7","doi-asserted-by":"publisher","first-page":"2590","DOI":"10.1093\/humrep\/deg478","volume":"18","author":"A Cagnacci","year":"2003","unstructured":"Cagnacci A, Pirillo D, Malmusi S, Arangino S, Alessandrini C, Volpe A. Early outcome of myomectomy by laparotomy, minilaparotomy and laparoscopically assisted minilaparotomy. A randomized prospective study. Hum Reprod. 2003;18:2590\u20134.","journal-title":"Hum Reprod"},{"key":"1217_CR8","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1002\/jmri.24998","volume":"43","author":"G Lin","year":"2016","unstructured":"Lin G, Yang LY, Huang YT, Ng KK, Ng SH, Ueng SH, et al. Comparison of the diagnostic accuracy of contrast-enhanced MRI and diffusion-weighted MRI in the differentiation between uterine leiomyosarcoma\/smooth muscle tumor with uncertain malignant potential and benign leiomyoma. J Magn Reson Imaging. 2016;43:333\u201342.","journal-title":"J Magn Reson Imaging"},{"issue":"3","key":"1217_CR9","doi-asserted-by":"publisher","first-page":"e26","DOI":"10.3802\/jgo.2018.29.e26","volume":"29","author":"TH Kim","year":"2018","unstructured":"Kim TH, Kim JW, Kim SY, Kim SH, Cho JY. What MRI features suspect malignant pure mesenchymal uterine tumors rather than uterine leiomyoma with cystic degeneration? J Gynecol Oncol. 2018;29(3):e26.","journal-title":"J Gynecol Oncol"},{"key":"1217_CR10","doi-asserted-by":"publisher","first-page":"4","DOI":"10.5152\/dir.2014.14053","volume":"21","author":"P Santos","year":"2015","unstructured":"Santos P, Cunha TM. Uterine sarcomas: clinical presentation and MRI features. Diagn Interv Radiol. 2015;21:4\u20139.","journal-title":"Diagn Interv Radiol"},{"key":"1217_CR11","doi-asserted-by":"publisher","first-page":"2737","DOI":"10.1007\/s00330-002-1405-3","volume":"12","author":"T Ohguri","year":"2002","unstructured":"Ohguri T, Aoki T, Watanabe H, Nakamura K, Nakata H, Matsuura Y, et al. MRI findings including gadolinium-enhanced dynamic studies of malignant, mixed mesodermal tumors of the uterus: differentiation from endometrial carcinomas. Eur Radiol. 2002;12:2737\u201342.","journal-title":"Eur Radiol"},{"key":"1217_CR12","doi-asserted-by":"publisher","first-page":"975","DOI":"10.1002\/jmri.22126","volume":"31","author":"R Furukawa","year":"2010","unstructured":"Furukawa R, Akahane M, Yamada H, Kiryu S, Sato J, Komatsu S, et al. Endometrial stromal sarcoma located in the myometrium with a low-intensity rim on T2-weighted images: report of three cases and literature review. J Magn Reson Imaging. 2010;31:975\u20139.","journal-title":"J Magn Reson Imaging"},{"key":"1217_CR13","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1016\/j.ejrad.2009.03.005","volume":"74","author":"D Cornfeld","year":"2010","unstructured":"Cornfeld D, Israel G, Martel M, Weinreb J, Schwartz P, McCarthy S. MRI appearance of mesenchymal tumors of the uterus. Eur J Radiol. 2010;74:241\u20139.","journal-title":"Eur J Radiol"},{"issue":"7","key":"1217_CR14","doi-asserted-by":"publisher","first-page":"2903","DOI":"10.1007\/s00330-016-4623-9","volume":"27","author":"Y Lakhman","year":"2017","unstructured":"Lakhman Y, Veeraraghavan H, Chaim J, Feier D, Goldman DA, Moskowitz CS, et al. Differentiation of uterine leiomyosarcoma from atypical leiomyoma: diagnostic accuracy of qualitative MR imaging features and feasibility of texture analysis. Eur Radiol. 2017;27(7):2903\u201315.","journal-title":"Eur Radiol"},{"key":"1217_CR15","doi-asserted-by":"publisher","first-page":"767","DOI":"10.2214\/ajr.173.3.10470920","volume":"173","author":"T Koyama","year":"1999","unstructured":"Koyama T, Togashi K, Konishi I, Kobayashi H, Ueda H, Kataoka ML, et al. MR imaging of endometrial stromal sarcoma: correlation with pathologic findings. AJR Am J Roentgenol. 1999;173:767\u201372.","journal-title":"AJR Am J Roentgenol"},{"key":"1217_CR16","doi-asserted-by":"publisher","first-page":"1268","DOI":"10.2214\/AJR.10.4419","volume":"195","author":"N Bharwani","year":"2010","unstructured":"Bharwani N, Newland A, Tunariu N, Babar S, Sahdev A, Rockall AG, et al. MRI appearances of uterine malignant mixed mullerian tumors. AJR Am J Roentgenol. 2010;195:1268\u201375.","journal-title":"AJR Am J Roentgenol"},{"key":"1217_CR17","doi-asserted-by":"publisher","first-page":"278","DOI":"10.2214\/AJR.07.3281","volume":"191","author":"SY Teo","year":"2008","unstructured":"Teo SY, Babagbemi KT, Peters HE, Mortele KJ. Primary malignant mixed mullerian tumor of the uterus: findings on sonography, CT, and gadolinium-enhanced MRI. AJR Am J Roentgenol. 2008;191:278\u201383.","journal-title":"AJR Am J Roentgenol"},{"key":"1217_CR18","doi-asserted-by":"publisher","first-page":"723","DOI":"10.1007\/s00330-007-0787-7","volume":"18","author":"K Tamai","year":"2008","unstructured":"Tamai K, Koyama T, Saga T, Morisawa N, Fujimoto K, Mikami Y, et al. The utility of diffusion-weighted MR imaging for differentiating uterine sarcomas from benign leiomyomas. Eur Radiol. 2008;18:723\u201330.","journal-title":"Eur Radiol"},{"key":"1217_CR19","doi-asserted-by":"crossref","unstructured":"Ueda H, Togashi K, Konishi I, Kataoka ML, Koyamat, Fujiwara T, et al. Unusual appearances of uterine leiomyomas: MR imaging findings and their histopathologic backgrounds. Radiographics. 1999;19:S131\u201345.","DOI":"10.1148\/radiographics.19.suppl_1.g99oc04s131"},{"issue":"6","key":"1217_CR20","doi-asserted-by":"publisher","first-page":"1405","DOI":"10.2214\/AJR.17.19234","volume":"211","author":"D DeMulder","year":"2018","unstructured":"DeMulder D, Ascher SM. Uterine leiomyosarcoma: can MRI differentiate leiomyosarcoma from benign leiomyoma before treatment? AJR Am J Roentgenol. 2018;211(6):1405\u201315.","journal-title":"AJR Am J Roentgenol"},{"issue":"3","key":"1217_CR21","doi-asserted-by":"publisher","first-page":"721","DOI":"10.1148\/radiology.189.3.8234695","volume":"189","author":"Y Yamashita","year":"1993","unstructured":"Yamashita Y, Torashima M, Takahashi M, Tanaka N, Katabuchi H, Miyazaki K, et al. Hyperintense uterine leiomyoma at T2-weighted MR imaging: differentiation with dynamic enhanced MR. Radiology. 1993;189(3):721\u20135.","journal-title":"Radiology"},{"issue":"8","key":"1217_CR22","doi-asserted-by":"publisher","first-page":"2306","DOI":"10.1007\/s00330-013-2819-9","volume":"23","author":"I Thomassin-Naggara","year":"2013","unstructured":"Thomassin-Naggara I, Dechoux S, Bonneau C, Morel A, Rouzier R, Carette MF, Darai E, Bazot M. How to differentiate benign from malignant myometrial tumours using MR imaging. Eur Radiol. 2013;23(8):2306\u201314.","journal-title":"Eur Radiol"},{"key":"1217_CR23","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1186\/s40644-019-0247-z","volume":"19","author":"YL Huang","year":"2019","unstructured":"Huang YL, Ueng SH, Chen K, Huang YT, Lu HY, Ng KK, et al. Utility of diffusion-weighted and contrast-enhanced magnetic resonance imaging in diagnosing and differentiating between high- and low-grade uterine endometrial stromal sarcoma. Cancer Imaging. 2019;19:63.","journal-title":"Cancer Imaging"},{"key":"1217_CR24","doi-asserted-by":"publisher","first-page":"159","DOI":"10.2307\/2529310","volume":"33","author":"JR Landis","year":"1977","unstructured":"Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159\u201374.","journal-title":"Biometrics"},{"issue":"2","key":"1217_CR25","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1016\/j.jcm.2016.02.012","volume":"15","author":"TK Koo","year":"2016","unstructured":"Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med. 2016;15(2):155\u201363.","journal-title":"J Chiropr Med"},{"key":"1217_CR26","doi-asserted-by":"publisher","first-page":"837","DOI":"10.2307\/2531595","volume":"44","author":"ER DeLong","year":"1988","unstructured":"DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988;44:837\u201345.","journal-title":"Biometrics"},{"key":"1217_CR27","doi-asserted-by":"publisher","first-page":"69","DOI":"10.2307\/2529937","volume":"35","author":"PA Lachenbruch","year":"1979","unstructured":"Lachenbruch PA, Goldstein M. Discriminant analysis. Biometrics. 1979;35:69\u201385.","journal-title":"Biometrics"},{"key":"1217_CR28","doi-asserted-by":"publisher","first-page":"993","DOI":"10.1016\/j.acra.2018.01.002","volume":"25","author":"Q Bi","year":"2018","unstructured":"Bi Q, Xiao Z, Lv F, Liu Y, Zou C, Shen Y. Utility of clinical parameters and multiparametric MRI as predictive factors for differentiating uterine sarcoma from atypical leiomyoma. Acad Radiol. 2018;25:993\u20131002.","journal-title":"Acad Radiol"},{"key":"1217_CR29","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1016\/j.ejrad.2019.04.004","volume":"115","author":"H Xie","year":"2019","unstructured":"Xie H, Hu J, Zhang X, Ma S, Liu Y, Wang X. Preliminary utilization of radiomics in differentiating uterine sarcoma from atypical leiomyoma: comparison on diagnostic efficacy of MRI features and radiomic features. Eur J Radiol. 2019;115:39\u201345.","journal-title":"Eur J Radiol"},{"key":"1217_CR30","doi-asserted-by":"publisher","first-page":"796","DOI":"10.1002\/mrm.22666","volume":"65","author":"DG Colvin","year":"2011","unstructured":"Colvin DG, Jourquin J, Xu J, Does MD, Estrade L, Gore JG. Effects of intracellular organelles on the apparent diffusion coefficient of water molecules in cultured human embryonic kidney cells. Magn Reson Med. 2011;65:796\u2013801.","journal-title":"Magn Reson Med"},{"key":"1217_CR31","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1093\/humupd\/8.1.60","volume":"8","author":"M Livingstone","year":"2002","unstructured":"Livingstone M, Fraser IS. Mechanisms of abnormal uterine bleeding. Hum Reprod Update. 2002;8:60\u20137.","journal-title":"Hum Reprod Update"},{"issue":"2","key":"1217_CR32","doi-asserted-by":"publisher","first-page":"573","DOI":"10.1148\/radiol.11101919","volume":"261","author":"MD Blackledge","year":"2011","unstructured":"Blackledge MD, Leach MO, Collins DJ, Koh DM. Computed diffusion-weighted MR imaging may improve tumor detection. Radiology. 2011;261(2):573\u201381.","journal-title":"Radiology"},{"key":"1217_CR33","first-page":"768291","volume":"2014","author":"V Metin","year":"2014","unstructured":"Metin V, G\u00f6khan E, Asl\u0131han O, \u00d6mer A, Tar\u0131k E, Ye\u015fim S, et al. Conspicuity of peripheral zone prostate cancer on computed diffusion-weighted imaging: comparison of cDWI1500, cDWI2000, and cDWI3000. Biomed Res Int. 2014;2014:768291.","journal-title":"Biomed Res Int"},{"key":"1217_CR34","doi-asserted-by":"publisher","first-page":"119","DOI":"10.2463\/mrms.mp.2018-0011","volume":"18","author":"T Tamura","year":"2019","unstructured":"Tamura T, Miyuki T, Higaki T, Yokomachi K, Akiyama Y, Sumida H, et al. How to improve the conspicuity of breast tumors on computed high b-value diffusion-weighted imaging. Magn Reason Med Sci. 2019;18:119\u201325.","journal-title":"Magn Reason Med Sci"},{"issue":"5","key":"1217_CR35","doi-asserted-by":"publisher","first-page":"1016","DOI":"10.1016\/j.ejrad.2016.03.009","volume":"85","author":"M Takeuchi","year":"2016","unstructured":"Takeuchi M, Kenji M, Harada M. Computed diffusion-weighted imaging for differentiating decidualized endometrioma from ovarian cancer. Eur J Radiol. 2016;85(5):1016\u20139.","journal-title":"Eur J Radiol"}],"container-title":["Japanese Journal of Radiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11604-021-01217-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11604-021-01217-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11604-021-01217-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,4,3]],"date-time":"2022-04-03T23:04:57Z","timestamp":1649027097000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11604-021-01217-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,9]]},"references-count":35,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2022,4]]}},"alternative-id":["1217"],"URL":"https:\/\/doi.org\/10.1007\/s11604-021-01217-2","relation":{},"ISSN":["1867-1071","1867-108X"],"issn-type":[{"value":"1867-1071","type":"print"},{"value":"1867-108X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,9]]},"assertion":[{"value":"18 June 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 October 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 November 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"We declare that we have no conflicts of interest with any organization or institute.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and\/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Informed consent was obtained from all individual participants included in the study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}]}}