Lymphangioleiomyomatosis (LAM) is a rare idiopathic disease and this is characterized by a proliferation of abnormal smooth muscle cells in the lungs and in the lymphatic system of the thorax and retroperitoneum. The female genital tract is rarely affected by LAM. We report here on the CT and MR imaging findings of extensive LAM involving the uterus and pelvic cavity, and this was seen as multiple cystic uterine and parauterine masses with internal hemorrhage in a young female with tuberous sclerosis complex.
Adnexal Diseases/*diagnosis/radiography/surgery ; Adult ; Diagnosis, Differential ; Female ; Humans ; Hysterectomy ; Lymphangioleiomyomatosis/*diagnosis/radiography/surgery ; *Magnetic Resonance Imaging ; *Tomography, X-Ray Computed ; Tuberous Sclerosis/diagnosis/radiography/surgery ; Uterine Neoplasms/*diagnosis/radiography/surgery

OBJECTIVE: To compare the diagnostic performance and radiation dose between contrast-enhanced CT (ECT) alone, and combined unenhanced and contrast-enhanced CT (UE + ECT) for the assessment of adnexal mass. MATERIALS AND METHODS: This retrospective study was approved by the Institutional Review Board. A total of 146 consecutive patients (mean age, 41.1 years) who underwent preoperative unenhanced and contrast-enhanced multidetector CT of the pelvis and had adnexal masses found at surgery were included. Two readers independently evaluated the likelihood of adnexal malignancy on a 5-point scale on two different imaging datasets (ECT alone and UE + ECT). The area under the receiver operating characteristic curve (AUC) was used to evaluate diagnostic performance. Radiation dose to patients was calculated by the volume CT dose index (CTDIvol) and the dose length products (DLP) on each dataset. RESULTS: Of the total 178 adnexal masses, 133 masses were benign and 45 masses were malignant. For both readers, there is no significant difference of AUC values between ECT alone and UE + ECT for the detection of adnexal malignancy (reader 1, 0.93 vs. 0.95; reader 2, 0.92 vs. 0.91) (p > 0.05). The mean CTDIvol (12.6 +/- 2.2 mGy) and DLP (641.2 +/- 137.2 mGy) of ECT alone was significantly lower than the mean CTDIvol (21.5 +/- 2.7 mGy) and DLP (923.6 +/- 158.8 mGy) of UE + ECT (p < 0.0001). CONCLUSION: The use of unenhanced CT scan in addition to contrast-enhanced CT scan does not improve the detection of adnexal malignancy, but increases radiation exposure.
Adnexal Diseases/*radiography/surgery ; Adolescent ; Adult ; Aged ; Child ; Cone-Beam Computed Tomography ; Contrast Media/*diagnostic use ; Female ; Humans ; Middle Aged ; Multidetector Computed Tomography/*methods ; ROC Curve ; Radiation Dosage ; Retrospective Studies ; Tomography, X-Ray Computed/methods ; Young Adult