{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,17]],"date-time":"2026-01-17T07:27:03Z","timestamp":1768634823124,"version":"3.49.0"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"1176","license":[{"start":{"date-parts":[[2025,7,23]],"date-time":"2025-07-23T00:00:00Z","timestamp":1753228800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study aims to compare apparent diffusion coefficient (ADC) findings between leiomyosarcoma (LMS) and atypical\/degenerate leiomyoma (LM) and evaluate the usefulness of this biomarker for diagnosis. Additionally it will explore the potential of preoperative neutrophil-lymphocyte ratio (NLR) as a haematological marker to aid in the differentiation of LMS from atypical LM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Histologically proven LMS and LM patients between 2013 and 2023 were included. For all patients (191 LM, 18 LMS), the preoperative full blood count was analysed, and the NLR calculated. Whole volume of interest (VOI) and focal region of interest (ROI) areas were manually segmented on patients with DW-MRI sequences available (52 LM, 12 LMS). Mann\u2013Whitney and Fishers exact test were used to assess statistical significance and receiver operating characteristic (ROC) curves for diagnostic performance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>VOI and ROI mean ADC values were significantly lower for LMS than LM, with ROI mean ADC demonstrating greater diagnostic accuracy (area under the curve, [AUC] 0.817 vs 0.755). Applying a threshold ROI mean ADC value of \u22641.00\u2009\u00d7\u200910\u22123 mm2\/s achieved a sensitivity and specificity of 88.3% and 65.4%, respectively. A higher NLR was suggestive of LMS (median 2.8 vs 1.7 for LM).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>ADC, particularly a focal ROI is useful in differentiating LMS from LM. Differences in preoperative blood markers, suggest an inflammatory-malignancy relationship. Future risk stratification models of ADC and haematological parameters should be explored.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Advances in knowledge<\/jats:title>\n                    <jats:p>This study adds to few studies comparing using both ROI- and VOI-based methods, and no study has assessed both haematological markers and ADC metrics to aid differentiation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/bjr\/tqaf172","type":"journal-article","created":{"date-parts":[[2025,7,23]],"date-time":"2025-07-23T18:28:58Z","timestamp":1753295338000},"page":"2106-2114","source":"Crossref","is-referenced-by-count":0,"title":["Using diffusion-weighted imaging and blood inflammatory markers to preoperatively differentiate between leiomyosarcoma and atypical leiomyomas"],"prefix":"10.1093","volume":"98","author":[{"given":"Saranya","family":"Das","sequence":"first","affiliation":[{"name":"Department of Surgery and Cancer, Imperial College London, Hammersmith Campus , London W12 0NN,","place":["United Kingdom"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-9664-8742","authenticated-orcid":false,"given":"Kavita","family":"Shapriya","sequence":"additional","affiliation":[{"name":"The Imaging Department, Imperial College Healthcare NHS Trust, Hammersmith Hospital , London W12 0HS,","place":["United Kingdom"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Da Silva","sequence":"additional","affiliation":[{"name":"The Imaging Department, Imperial College Healthcare NHS Trust, Hammersmith Hospital , London W12 0HS,","place":["United Kingdom"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xingfeng","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Surgery and Cancer, Imperial College London, Hammersmith Campus , London W12 0NN,","place":["United Kingdom"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alastair","family":"Jackson","sequence":"additional","affiliation":[{"name":"Department of Surgery and Cancer, Imperial College London, Hammersmith Campus , London W12 0NN,","place":["United Kingdom"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6236-1480","authenticated-orcid":false,"given":"Nishat","family":"Bharwani","sequence":"additional","affiliation":[{"name":"Department of Surgery and Cancer, Imperial College London, Hammersmith Campus , London W12 0NN,","place":["United Kingdom"]},{"name":"The Imaging Department, Imperial College Healthcare NHS Trust, Hammersmith Hospital , London W12 0HS,","place":["United Kingdom"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Baljeet","family":"Kaur","sequence":"additional","affiliation":[{"name":"Department of Histopathology, Charing Cross Gestational Trophoblastic Disease Centre, Charing Cross Hospital, Imperial College London , London W6 8RF,","place":["United Kingdom"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8270-5597","authenticated-orcid":false,"given":"Andrea G","family":"Rockall","sequence":"additional","affiliation":[{"name":"Department of Surgery and Cancer, Imperial College London, Hammersmith Campus , London W12 0NN,","place":["United Kingdom"]},{"name":"The Imaging Department, Imperial College Healthcare NHS Trust, Hammersmith Hospital , London W12 0HS,","place":["United Kingdom"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,7,23]]},"reference":[{"key":"2026011615172034200_tqaf172-B1","doi-asserted-by":"publisher","first-page":"202","DOI":"10.4103\/0976-7800.145175","article-title":"Uterine leiomyosarcoma: a case report","volume":"5","author":"Kaur","year":"2014","journal-title":"J MidLife Health"},{"key":"2026011615172034200_tqaf172-B2","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1016\/j.ygyno.2009.09.023","article-title":"Uterine sarcomas: a review","volume":"116","author":"D'Angelo","year":"2010","journal-title":"Gynecol Oncol"},{"key":"2026011615172034200_tqaf172-B3","doi-asserted-by":"publisher","first-page":"e211658","DOI":"10.1148\/radiol.211658","article-title":"MRI evaluation of uterine masses for risk of leiomyosarcoma: a consensus statement","volume":"306","author":"Hindman","year":"2023","journal-title":"Radiology"},{"key":"2026011615172034200_tqaf172-B4","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1006\/gyno.1996.0185","article-title":"Uterine leiomyosarcoma: analysis of treatment failures and survival","volume":"62","author":"Gadducci","year":"1996","journal-title":"Gynecol Oncol"},{"key":"2026011615172034200_tqaf172-B5","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1067\/mob.2003.99","article-title":"High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence","volume":"188","author":"Day Baird","year":"2003","journal-title":"Am J Obstet Gynecol"},{"key":"2026011615172034200_tqaf172-B6","doi-asserted-by":"publisher","first-page":"1228","DOI":"10.1111\/aogs.13008","article-title":"Preoperative evaluation in women with uterine leiomyosarcoma. A nationwide cohort study","volume":"95","author":"Skorstad","year":"2016","journal-title":"Acta Obstet Gynecol Scand"},{"key":"2026011615172034200_tqaf172-B7","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1002\/ijgo.15136","article-title":"Diagnostic accuracy of MRI in the differential diagnosis between uterine leiomyomas and sarcomas: a systematic review and meta-analysis","volume":"165","author":"Raffone","year":"2023","journal-title":"Int J Gynaecol Obstet"},{"key":"2026011615172034200_tqaf172-B8","doi-asserted-by":"publisher","first-page":"2903","DOI":"10.1007\/s00330-016-4623-9","article-title":"Differentiation of uterine leiomyosarcoma from atypical leiomyoma: diagnostic accuracy of qualitative MR imaging features and feasibility of texture analysis","volume":"27","author":"Lakhman","year":"2017","journal-title":"Eur Radiol"},{"key":"2026011615172034200_tqaf172-B9","doi-asserted-by":"publisher","first-page":"785","DOI":"10.4329\/wjr.v8.i9.785","article-title":"Diffusion weighted imaging: technique and applications","volume":"8","author":"Baliyan","year":"2016","journal-title":"World J Radiol"},{"key":"2026011615172034200_tqaf172-B10","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1111\/jog.13792","article-title":"Diagnostic value of combination serum assay of lactate dehydrogenase, D-dimer, and C-reactive protein for uterine leiomyosarcoma","volume":"45","author":"Nishigaya","year":"2019","journal-title":"J Obstet Gynaecol Res"},{"key":"2026011615172034200_tqaf172-B11","doi-asserted-by":"publisher","first-page":"701","DOI":"10.31557\/apjcp.2023.24.2.701","article-title":"Neutrophil-to-lymphocyte ratio (NLR) for preoperative differentiation between uterine leiomyosarcoma (LMS) and uterine leiomyoma: a case-controlled study","volume":"24","author":"Srisutha","year":"2023","journal-title":"Asian Pac J Cancer Prev"},{"key":"2026011615172034200_tqaf172-B12","doi-asserted-by":"publisher","first-page":"5001","DOI":"10.2147\/cmar.s314219","article-title":"Preoperative blood inflammatory markers for the differentiation of uterine leiomyosarcoma from leiomyoma","volume":"13","author":"Suh","year":"2021","journal-title":"Cancer Manag Res"},{"key":"2026011615172034200_tqaf172-B13","doi-asserted-by":"publisher","first-page":"514","DOI":"10.1186\/s12885-020-07003-z","article-title":"Preoperative clinical characteristics scoring system for differentiating uterine leiomyosarcoma from fibroid","volume":"20","author":"Zhang","year":"2020","journal-title":"BMC Cancer"},{"key":"2026011615172034200_tqaf172-B14","volume-title":"WHO Classification of Tumours Series","author":"WHO Classification of Tumours Editorial Board","year":"2020","edition":"5th ed"},{"key":"2026011615172034200_tqaf172-B15","doi-asserted-by":"publisher","first-page":"1742","DOI":"10.1007\/s00261-014-0324-5","article-title":"Differential diagnosis of uterine smooth muscle tumors using diffusion-weighted imaging: correlations with the apparent diffusion coefficient and cell density","volume":"40","author":"Tasaki","year":"2015","journal-title":"Abdom Imaging"},{"key":"2026011615172034200_tqaf172-B16","doi-asserted-by":"publisher","first-page":"599","DOI":"10.1097\/RCT.0000000000000565","article-title":"Diffusion-weighted imaging for differentiating uterine leiomyosarcoma from degenerated leiomyoma","volume":"41","author":"Li","year":"2017","journal-title":"J Comput Assist Tomogr"},{"key":"2026011615172034200_tqaf172-B17","doi-asserted-by":"publisher","first-page":"e34452","DOI":"10.1097\/MD.0000000000034452","article-title":"Quantitative MR texture analysis for the differentiation of uterine smooth muscle tumors with high signal intensity on T2-weighted imaging","volume":"102","author":"Kumagai","year":"2023","journal-title":"Medicine (Baltimore)"},{"key":"2026011615172034200_tqaf172-B18","doi-asserted-by":"publisher","first-page":"1172","DOI":"10.2214\/ajr.17.18605","article-title":"Explorative investigation of whole-lesion histogram MRI metrics for differentiating uterine leiomyomas and leiomyosarcomas","volume":"210","author":"Gerges","year":"2018","journal-title":"Am J Roentgenol"},{"key":"2026011615172034200_tqaf172-B19","doi-asserted-by":"publisher","first-page":"3388","DOI":"10.1007\/s00261-019-02097-x","article-title":"T2 hyperintense myometrial tumors: can MRI features differentiate leiomyomas from leiomyosarcomas?","volume":"44","author":"Rio","year":"2019","journal-title":"Abdom Radiol"},{"key":"2026011615172034200_tqaf172-B20","doi-asserted-by":"publisher","first-page":"368.e1","DOI":"10.1016\/j.ajog.2013.12.028","article-title":"Clinical application of diffusion-weighted imaging for preoperative differentiation between uterine leiomyoma and leiomyosarcoma","volume":"210","author":"Sato","year":"2014","journal-title":"Am J Obstet Gynecol"},{"key":"2026011615172034200_tqaf172-B21","doi-asserted-by":"publisher","first-page":"20210115","DOI":"10.1259\/bjr.20210115","article-title":"Diagnostic interpretation of non-contrast qualitative MR imaging features for characterisation of uterine leiomyosarcoma","volume":"94","author":"Sahin","year":"2021","journal-title":"Br J Radiol"},{"key":"2026011615172034200_tqaf172-B22","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1002\/jmri.24998","article-title":"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","volume":"43","author":"Lin","year":"2016","journal-title":"J Magn Reson Imaging"},{"key":"2026011615172034200_tqaf172-B23","doi-asserted-by":"publisher","first-page":"723","DOI":"10.1007\/s00330-007-0787-7","article-title":"The utility of diffusion-weighted MR imaging for differentiating uterine sarcomas from benign leiomyomas","volume":"18","author":"Tamai","year":"2008","journal-title":"Eur Radiol"},{"key":"2026011615172034200_tqaf172-B24","doi-asserted-by":"publisher","first-page":"571.e9","DOI":"10.1016\/j.crad.2019.03.011","article-title":"Diagnostic value of 3 T MR spectroscopy, diffusion-weighted MRI, and apparent diffusion coefficient value for distinguishing benign from malignant myometrial tumours","volume":"74","author":"Rahimifar","year":"2019","journal-title":"Clin Radiol"},{"key":"2026011615172034200_tqaf172-B25","doi-asserted-by":"publisher","first-page":"2306","DOI":"10.1007\/s00330-013-2819-9","article-title":"How to differentiate benign from malignant myometrial tumours using MR imaging","volume":"23","author":"Thomassin-Naggara","year":"2013","journal-title":"Eur Radiol"},{"key":"2026011615172034200_tqaf172-B26","doi-asserted-by":"publisher","first-page":"735","DOI":"10.3390\/diagnostics10100735","article-title":"Developing a preoperative algorithm for the diagnosis of uterine leiomyosarcoma","volume":"10","author":"Lawlor","year":"2020","journal-title":"Diagnostics"},{"key":"2026011615172034200_tqaf172-B27","doi-asserted-by":"publisher","first-page":"691","DOI":"10.1016\/j.ejso.2010.05.004","article-title":"Neutrophil to lymphocyte ratio for preoperative diagnosis of uterine sarcomas: a case-matched comparison","volume":"36","author":"Kim","year":"2010","journal-title":"Eur J Surg Oncol"},{"key":"2026011615172034200_tqaf172-B28","doi-asserted-by":"publisher","first-page":"565165","DOI":"10.3389\/fimmu.2020.565165","article-title":"Neutrophil: a new player in metastatic cancers","volume":"11","author":"Wu","year":"2020","journal-title":"Front Immunol"},{"key":"2026011615172034200_tqaf172-B29","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1186\/s12885-023-11775-5","article-title":"Neutrophil to lymphocyte ratio as an assessment tool to differentiate between uterine sarcoma and myoma: a systematic review and meta-analysis","volume":"24","author":"Tabatabaei","year":"2024","journal-title":"BMC Cancer"},{"key":"2026011615172034200_tqaf172-B30","doi-asserted-by":"publisher","first-page":"1080","DOI":"10.3390\/cancers15041080","article-title":"Systemic inflammatory indices in second-line soft tissue sarcoma patients: focus on lymphocyte\/monocyte ratio and trabectedin","volume":"15","author":"Fausti","year":"2023","journal-title":"Cancers"},{"key":"2026011615172034200_tqaf172-B31","doi-asserted-by":"publisher","first-page":"332","DOI":"10.1016\/j.ygyno.2015.05.019","article-title":"Significance of monocyte counts on tumor characteristics and survival outcome of women with endometrial cancer","volume":"138","author":"Matsuo","year":"2015","journal-title":"Gynecol Oncol"},{"key":"2026011615172034200_tqaf172-B32","doi-asserted-by":"publisher","first-page":"20210157","DOI":"10.1259\/bjr.20210157","article-title":"Ovary: MRI characterisation and O-RADS MRI","volume":"94","author":"Sadowski","year":"2021","journal-title":"Br J Radiol"},{"key":"2026011615172034200_tqaf172-B33","doi-asserted-by":"publisher","first-page":"4927","DOI":"10.1007\/s00261-021-03132-6","article-title":"Differentiating leiomyosarcoma from leiomyoma: in support of an MR imaging predictive scoring system","volume":"46","author":"Jagannathan","year":"2021","journal-title":"Abdom Radiol"},{"key":"2026011615172034200_tqaf172-B34","doi-asserted-by":"publisher","first-page":"BSR20193875","DOI":"10.1042\/bsr20193875","article-title":"Evaluation of models for predicting the probability of malignancy in patients with pulmonary nodules","volume":"40","author":"Li","year":"2020","journal-title":"Biosci Rep"}],"container-title":["British Journal of Radiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/bjr\/advance-article-pdf\/doi\/10.1093\/bjr\/tqaf172\/63834831\/tqaf172.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/bjr\/article-pdf\/98\/1176\/2106\/63834831\/tqaf172.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/bjr\/article-pdf\/98\/1176\/2106\/63834831\/tqaf172.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T20:17:31Z","timestamp":1768594651000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/bjr\/article\/98\/1176\/2106\/8211160"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,23]]},"references-count":34,"journal-issue":{"issue":"1176","published-online":{"date-parts":[[2025,7,23]]},"published-print":{"date-parts":[[2025,12,1]]}},"URL":"https:\/\/doi.org\/10.1093\/bjr\/tqaf172","relation":{},"ISSN":["0007-1285","1748-880X"],"issn-type":[{"value":"0007-1285","type":"print"},{"value":"1748-880X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,12]]},"published":{"date-parts":[[2025,7,23]]}}}