Department of Radiology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109.
Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109.
Acad Radiol. 2018 Apr;25(4):439-444. doi: 10.1016/j.acra.2017.10.011. Epub 2017 Dec 11.
Women with pelvic pain or abnormal uterine bleeding may undergo diagnostic imaging. This study evaluates patient experience in transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI) and explores correlations between preference and symptom severity.
Institutional review board approval was obtained for this Health Insurance Portability and Accountability Act-compliant prospective study. Fifty premenopausal women with pelvic symptoms evaluated by recent TVUS and MRI and without history of gynecologic cancer or hysterectomy were included. A phone questionnaire used validated survey instruments including Uterine Fibroid Symptoms Quality of Life index, Testing Morbidities Index, and Wait Trade Off for TVUS and MRI examinations.
Using Wait Trade Off, patients preferred TVUS over MRI (3.58 vs 2.80 weeks, 95% confidence interval [CI] -1.63, 0.12; P = .08). Summary test utility of Testing Morbidities Index for MRI was worse than for TVUS (81.64 vs 87.42, 95%CI 0.41, 11.15; P = .03). Patients reported greater embarrassment during TVUS than during MRI (P <.0001), but greater fear and anxiety both before (P <.0001) and during (P <.001) MRI, and greater mental (P = .02) and physical (P = .02) problems after MRI versus TVUS. Subscale correlations showed physically inactive women rated TVUS more negatively (R = -0.32, P = .03), whereas women with more severe symptoms of loss of control of health (R = -0.28, P = .04) and sexual dysfunction (R = -0.30, P = .03) rated MRI more negatively.
Women with pelvic symptoms had a slight but significant preference for TVUS over MRI. Identifying specific distressing aspects of each test and patient factors contributing to negative perceptions can direct improvement in both test environment and patient preparation. Improved patient experience may increase imaging value.
患有盆腔疼痛或异常子宫出血的女性可能需要接受诊断性影像学检查。本研究评估了经阴道超声（TVUS）和磁共振成像（MRI）的患者体验，并探讨了偏好与症状严重程度之间的相关性。
本研究获得了机构审查委员会的批准，为符合《健康保险流通与责任法案》的前瞻性研究。共纳入 50 例近期接受 TVUS 和 MRI 检查且无妇科癌症或子宫切除术史的有盆腔症状的绝经前女性。采用电话问卷调查，使用经过验证的调查工具，包括子宫纤维瘤症状生活质量指数、检查不良事件指数和 TVUS 和 MRI 检查的等待权衡。
使用等待权衡，患者更喜欢 TVUS 而不是 MRI（3.58 比 2.80 周，95%置信区间[CI] -1.63，0.12；P =.08）。MRI 的 Testing Morbidities Index 综合测试效用差于 TVUS（81.64 比 87.42，95%CI 0.41，11.15；P =.03）。与 MRI 相比，患者在 TVUS 检查过程中感到更加尴尬（P <.0001），但在 MRI 检查前（P <.0001）和检查期间（P <.001）感到更加恐惧和焦虑，且在 MRI 检查后出现更多的心理（P =.02）和身体问题（P =.02）。子量表相关性显示，不常运动的女性对 TVUS 的评价更差（R = -0.32，P =.03），而对健康失控感（R = -0.28，P =.04）和性功能障碍（R = -0.30，P =.03）症状更严重的女性对 MRI 的评价更差。
有盆腔症状的女性对 TVUS 稍偏好于 MRI。确定每项检查的具体令人痛苦的方面和导致负面认知的患者因素，可以改善检查环境和患者准备。提高患者体验可能会增加影像学检查的价值。
