Department of Radiology, Stanford University, Stanford, California, USA.
Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM), Québec, Canada.
J Magn Reson Imaging. 2019 Jun;49(7):e271-e281. doi: 10.1002/jmri.26620. Epub 2019 Jan 5.
Pelvic ultrasound (US) diagnosis of uterine fibroids may overlook coexisting gynecological conditions that contribute to women's symptoms.
To determine the added value of pelvic MRI for women diagnosed with symptomatic fibroids by US, and to identify clinical factors associated with additional MRI findings.
Retrospective observational study.
In all, 367 consecutive women with fibroids diagnosed by US and referred to our multidisciplinary fibroid center between 2013-2017.
FIELD STRENGTH/SEQUENCE: All patients had both pelvic US and MRI prior to their consultations. MRIs were performed at 1.5 T or 3 T and included multiplanar T -weighted sequences, and precontrast and postcontrast T -weighted imaging.
Demographics, symptoms, uterine fibroid symptom severity scores, and health-related quality of life scores, as well as imaging findings were evaluated.
Patients were separated into two subgroups according to whether MRI provided additional findings to the initial US. Univariate and multivariate regression analyses were performed.
Pelvic MRI provided additional information in 162 patients (44%; 95% confidence interval [CI] 39-49%). The most common significant findings were adenomyosis (22%), endometriosis (17%), and partially endocavitary fibroids (15%). Women with pelvic pain, health-related quality of life scores less than 30 out of 100, or multiple fibroids visualized on US had greater odds of additional MRI findings (odds ratio [OR] 1.68, 2.26, 1.63; P = 0.02, 0.004, 0.03, respectively), while nulliparous women had reduced odds (OR 0.55, P = 0.01). Patients with additional MRI findings were treated less often with uterine fibroid embolization (14% vs. 36%, P < 0.001) or MR-guided focused US (1% vs. 5%, P = 0.04), and more often with medical management (17% vs. 8%, P = 0.01).
Pelvic MRI revealed additional findings in more than 40% of women presenting with symptoms initially ascribed to fibroids by US. Further evaluation using MRI is particularly useful for parous women with pelvic pain, poor quality of life scores, and/or multiple fibroids.
4 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2019.
盆腔超声（US）诊断子宫肌瘤可能会忽略导致女性症状的共存妇科疾病。
确定盆腔 MRI 对通过 US 诊断为有症状的子宫肌瘤的女性的附加价值，并确定与额外 MRI 结果相关的临床因素。
回顾性观察性研究。
2013 年至 2017 年间，共有 367 例连续因 US 诊断为子宫肌瘤且转诊至我们多学科子宫肌瘤中心的女性。
磁场强度/序列：所有患者在就诊前均进行盆腔 US 和 MRI 检查。MRI 在 1.5T 或 3T 上进行，包括多平面 T1 加权序列，以及对比前和对比后 T1 加权成像。
评估了人口统计学数据、症状、子宫肌瘤症状严重程度评分和健康相关生活质量评分以及影像学发现。
根据 MRI 是否为初始 US 提供了附加信息，将患者分为两组。进行了单变量和多变量回归分析。
盆腔 MRI 为 162 例患者（44%；95%置信区间 [CI] 39-49%）提供了额外信息。最常见的显著发现是腺肌病（22%）、子宫内膜异位症（17%）和部分宫腔内肌瘤（15%）。有盆腔疼痛、健康相关生活质量评分低于 100 分中的 30 分或 US 上显示多个肌瘤的女性，有更高的出现额外 MRI 发现的几率（比值比 [OR] 1.68、2.26、1.63；P=0.02、0.004、0.03），而未产妇的几率降低（OR 0.55，P=0.01）。有额外 MRI 发现的患者接受子宫肌瘤栓塞术（14%比 36%，P<0.001）或磁共振引导聚焦超声（1%比 5%，P=0.04）治疗的可能性较低，而接受药物治疗（17%比 8%，P=0.01）的可能性较高。
盆腔 MRI 显示出，在最初由 US 诊断为子宫肌瘤的症状的女性中，超过 40%有额外发现。对于有盆腔疼痛、生活质量评分差和/或多个肌瘤的经产妇，进一步使用 MRI 评估尤其有用。
4 级技术功效：3 期 J. Magn. Reson. Imaging 2019.
