Preoperative diagnosis of cervical cystic lesions by magnetic resonance imaging

Abstract Background To clarify the magnetic resonance imaging (MRI) characteristics of lobular endocervical glandular hyperplasia (LEGH) and Nabothian cysts. Methods This study included 48 patients who underwent hysterectomy at our institution between 2016 and 2020 for suspected LEGH. Histopathology confirmed the presence of 25 Nabothian cysts and 23 cases of LEGH. We retrospectively analyzed five characteristic MRI findings: (1) located at the upper cervical canal; (2) positioned within the cervical stroma; (3) not circumscribing the cervical canal; (4) low- to iso-intensity on T1-weighted images (T1WI) (5) a “cosmos” or “microcystic” pattern. We compared the diagnostic accuracy of these findings for LEGH and Nabothian cysts using sensitivity, specificity, and predictive values. Combinations of findings were also calculated. Results The characteristics “cosmos” or “microcystic” pattern, lesion not circumscribing the cervical canal, and low/iso-intensity on T1WI had a sensitivity and specificity greater than 50%. Sensitivity was 73.9% and specificity was 84.0% when a combination of “cosmos” or “microcystic” pattern and lesion not circumscribing the cervical canal was present. Conclusion The coexistence of a “cosmos” or “microcystic” pattern and not circumscribing the cervical canal is the most characteristic finding to distinguish LEGH from Nabothian cysts. When neither of these findings is present, Nabothian cyst can be suspected.