ABSTRACT

Leiomyomas (LM) are easy to recognize on ultrasound (US) and magnetic resonance imaging (MRI), when they are typical. On the other hand, LM variants may differ in imaging findings. It is difficult to distinguish atypical LM from leiomyosarcoma (LMS). The presence of peritoneal implant/lymphadenopathy, having a signal equal to or higher than the myometrium in T2W images, having a signal equal to or higher than the endometrium in diffusion weighted imaging, and having a low signal in apparent diffusion coefficient map are among the MRI findings associated with LMS that have been reported to be at a high level of evidence. Adenomyoma may be confused with LM. Diagnosis can be made with US, but MRI is accepted as gold standard. A solid mass with ill-defined borders, internal vascularization, mild mass effect in an asymmetrically enlarged uterus may raise suspicion for adenomyoma; findings related with adenomyosis may accompany. Especially subserous LM can be confused with other adnexial lesions. If the ovary-related T2W black lesion is white on T1W images, it can be an endometrioma, or if it is black with mild contrast enhancement, it can be an ovarian fibroma. As a radiologist, in case of pelvic lesions, we must make sure the location of the lesion and then look for whole imaging findings.