A comparative study between magnetic resonance imaging and transvaginal sonography for evaluation of uterine fibroid using histopathology as a gold standard
Keywords:Histopathology, Magnetic resonance imaging, Myoma, Transvaginal ultrasound, Uterus
Background: Uterine fibroids constitute a substantial bulk of patients presenting to Gynaecology department. Many newer imaging modalities have evolved for their correct evaluation, but in a developing country like India, ultrasound is still being used as a screening as well as diagnostic modality. So, this study was done to compare ultrasound and magnetic resonance imaging for evaluation of uterine fibroids in terms of their sensitivity, specificity Trans vaginal and positive predictive value using Histopathology as a gold standard so as to improvise on current clinical practices in this country.
Methods: An ethically approved prospective study was done upon 50 patients with suspected uterine masses at SMS Hospital Jaipur. All included patients underwent Trans vaginal Ultrasound (TVS) and Magnetic resonance imaging (MRI) and were accordingly treated surgically. Histopathology report was traced postoperatively. Data was collected and subjected to various statistical tests including Cohen’s kappa.
Results: Most of the patients were <50 years and presented with complains of pain abdomen. Among total 50 cases, the sensitivity of TVS and MRI was 44% and 92%, specificity was 96% and 88%, PPV was 91.67% and 88.46%, NPV was 63.16% and 91.67% respectively, kappa was 0.40 and 0.80 i.e. agreement between TVS and MRI v/s HPE was 40% and 80% respectively. The diagonal agreement between transvaginal USG and MRI, was 63%.
Conclusions: TVS is a good screening modality but MRI is definitely better for proper characterization and localization of fibroids enabling clinicians to select the most appropriate management in everyday clinical practice.
Padubidri VG, Daftary SN. Shaw’s text book of gynaecology. In: Kumar S, eds. 17th ed. India: Elsevier-Saunder, Mosby, Churchill; 2018: 344-368.
Murase ES, Outwater EK, Rere Z, Jaffe LO, Tureck RW. Uterine leiomyomas histopathologic features, MR imaging findings, differential diagnosis and treatment. Radiographics. 1999;19(5):1179-97.
Khan AT, Shehmar M, Gupta JK . Uterine fibroids: current perspectives. Int J Womens Health. 2014;6: 95-114.
Shankar MPS , Kumar SR, Dhar T, Venkateshwaran KN, Balaji R. Role of Magnetic Resonance Imaging in Evaluation of Uterine Pathologies and its Correlation with Ultrasound. Int J Anat Radiol Surg. 2019 Apr;8(2):28-32.
Aubel S, Wozney P, Edwards RP. MRI of female uterine and juxta-uterine masses: clinical application in 25 patients. Magn Reson Imaging. 1991;9(4):485-91.
Levens ED, Wesley R, Premkumar A, Blocker W, MSN, Lynnette KN. Magnetic resonance imaging and transvaginal ultrasound for determining fibroid burden: implications for clinical research. Am J Obstet Gynecol. 2009 May;200(5):537e1-7.
Jagannathan D, Subramanian AD. Comparison of The Diagnostic Accuracy of Magnetic Resonance Imaging (MRI), Transabdominal Ultrasound (TAS), Transvaginal Ultrasound (TVS) In Characterizing The Uterine Mass Lesions. J Dent Med Scie. Feb. 2017;16(2):65-74.
Stamatopoulos CP, Mikos T, Grimbizis GF, Dimitriadis AS, Efstratiou I, Stamatopoulos P, et al. Value of magnetic resonance imaging in diagnosis of adenomyosis and myomas of the uterus. J Minim Invasive Gynecol. 2012 Sep-Oct;19(5):620-26.
Dueholm M, Lundorf E, Hansen ES, Ledertoug S, Olesen F. Accuracy of magnetic resonance imaging and transvaginal ultrasonography in the diagnosis, mapping, and measurement of uterine myomas. Am J Obstet Gynecol. 2002 Mar;186(3):409-15.
Zawin M, McCarthy S, Scoutt LM, Comite F. High field MRI and US evaluation of the pelvis in women with leiomyomas. Magn Reson Imag 1990;8(4):371-6.
Adam A, Dixon A, Gillard J, Prokop CS, Grainger R. Grainger & Allison’s Diagnostic Radiology: A Textbook of Medical Imaging. 6th ed. New York, NY: Elsevier; 2014: 1061-1063
Baret AL, Heuck FH W, Youker JE. Radiology of the female pelvic organs. 1st ed. New York, NY: Springer;1998: 134-140
Fleischer AC, Manning FA, Jeanty P, Romero R. Sonography in obstetrics & gynaecology: Principles and Practice. 6th ed. Europe: McGraw Hill; 2002: 245-250.