Uterine fibroids, also known as leiomyomas, are the commonest uterine neoplasms. Although benign, they can be associated with significant morbidity and are the commonest indication for hysterectomy. They are often discovered incidentally when performing imaging for other reasons. Usually first identified with USG, they can be further characterized with MRI. Magnetic resonance (MR) imaging is the most accurate imaging technique for detection and localization of leiomyomas. On T2-weighted images, nondegenerated leiomyomas appear as well-circumscribed masses of decreased signal intensity; however, cellular leiomyomas can have relatively higher signal intensity on T2-weighted images and demonstrate enhancement on contrast material–enhanced images. Degenerated leiomyomas have variable appearances on T2-weighted images and contrast-enhanced images. The differential diagnosis of leiomyomas includes adenomyosis, solid adnexal mass, focal myometrial contraction, and uterine leiomyosarcoma. MR imaging also has a role in treatment of leiomyomas by assisting in surgical planning and monitoring the response to medical therapy. Knowledge of the different appearances of fibroids on imaging is important as it enables prompt diagnosis and thereby guides treatment.
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