Clinical and magnetic resonance imaging characteristics of vaginal and paraurethral leiomyomas: can they be diagnosed before surgery?

Study Type – Diagnostic (non-consecutive) Level of Evidence 3b OBJECTIVE To describe the clinical and magnetic resonance imaging (MRI) characteristics of vaginal and paraurethral leiomyomas. PATIENTS AND METHODS All patients with pathologically confirmed paraurethral and vaginal wall leiomyomas from January 2006 to August 2007 were reviewed. Patients with no preoperative MRI of the pelvis were excluded. RESULTS Five patients were identified; all had a firm, smooth, non-tender, non-fluctuant mass. MRI showed a well-circumscribed shape, a homogeneous signal that was hypointense or isointense to muscle on T1- and hyperintense or isointense to muscle on T2-weighted images, and uniform enhancement. In all cases, MRI excluded urethral diverticulae, and pathology showed leiomyoma, of which one had atypical features. CONCLUSION Paraurethral and vaginal wall leiomyomas can be identified before surgery with a reasonable degree of certainty, based on their clinical and MRI characteristics.