Evaluation of the Viability of Untreated Leiomyomas Using Computed Tomography-Detected Calcification Patterns

Objective To evaluate the relationship between computed tomography (CT)-detected calcification patterns and Magnetic Resonance Imaging (MRI) enhancement as a surrogate for viability in untreated uterine leiomyomas. Methods We queried 2 university hospital databases to identify patients with: (1) at least 1 calcified leiomyoma on CT greater than 1 cm (2) contrast-enhanced MRI of the pelvis performed within 5 years of the CT, and (3) no prior history of uterine fibroid embolization (UFE). Computed tomography was used to analyze calcification pattern and contrast-enhanced MRI to analyze size and viability. Results There were 12,862 reports that fit the criteria. After exclusion, 50 patients with 74 calcified untreated leiomyomas were analyzed. Three calcification patterns were identified: rim (n = 22), diffuse (n = 9), and coarse either less than or greater than 50% (n = 43). Four of 22 (18%) of leiomyomas with rim calcification were viable. Three of 9 (33%) of leiomyomas with diffuse calcification were viable. All leiomyomas with coarse calcifications were viable, 43 of 43 (100%). Conclusions Leiomyomas with coarse calcifications are viable, whereas the majority with rim or diffuse calcification are not. This information may be helpful when triaging symptomatic women to treatment.