Accuracy of magnetic resonance imaging and transvaginal ultrasonography in the diagnosis, mapping, and measurement of uterine myomas

doi:10.1067/mob.2002.121725

American Journal of Obstetrics and Gynecology

Volume 186, Issue 3, March 2002, Pages 409-415

https://doi.org/10.1067/mob.2002.121725 Get rights and content

Abstract

OBJECTIVE: The purpose of this study was to evaluate and compare the accuracy of magnetic resonance imaging and transvaginal ultrasonography in myoma diagnosis, mapping, and measurement. STUDY DESIGN: This was a double-blind study of 106 consecutive premenopausal women who underwent hysterectomy for benign reasons. Myomas (total, 257) were exactly mapped by magnetic resonance imaging and transvaginal ultrasonography; in each patient, we counted correctly identified myomas with pathologic position as true value. RESULTS: The presence of myomas was detected with the same high level of precision by both methods (magnetic resonance imaging: sensitivity, 0.99; specificity, 0.86; transvaginal ultrasonography: sensitivity, 0.99; specificity, 0.91). The mean number of correctly identified myomas was significantly higher by magnetic resonance imaging than by transvaginal ultrasonography (mean difference, 0.51 ± 1.03; P <.001), a difference that narrowed to 0.08 ± 0.76 (P =.60) in 26 patients with 1 to 4 myomas and uterine volumes <375 mL. Magnetic resonance imaging and transvaginal ultrasonography myoma diameter measurements had equal and high accuracies in patients with 1 to 4 myomas. CONCLUSION: Transvaginal ultrasonography is as efficient as magnetic resonance imaging in detecting myoma presence, but its capacity for exact myoma mapping falls short of that of magnetic resonance imaging, especially in large (>375 mL) multiple-myoma (>4) uteri. (Am J Obstet Gynecol 2002;186:409-15.)

Section snippets

Patients

The study included 108 consecutive premenopausal patients who were scheduled for hysterectomy at a university hospital from September 1998 to February 2000. All patients gave their informed consent. Patients with previous transcervical endometrial resection, malignant diagnosis, and acute or subacute indication for hysterectomy were excluded. The indications for hysterectomy were abnormal uterine bleeding in 51 patients (48%), symptomatic myomas in 35 patients (33%), lower abdominal pain or

Results

For stating the presence of myomas, TVS and MRI were highly accurate, and their sensitivities and specificities for myoma detection were in line (Table I).

. Diagnostic accuracy in myoma detection by TVS, MRI compared with the true finding of myomas by pathology

Empty Cell	Myomas	No myomas	Diagnostic accuracy	%	95% CI
Empty Cell	Pathologic evidence (n)		Diagnostic accuracy	%	95% CI
TVS
Myomas by TVS	72	3*	Sensitivity	99	92-100
			Specificity	91	75-98
No myomas by TVS	1	30	Positive predictive value	96	88-99
			Negative predictive value	97	82-100
MRI
Myomas by MRI	72	6*	Sensitivity	99

Comment

This study found that MRI and TVS were equally highly accurate in ascertaining the presence of myomas but that MRI was superior to TVS for the mapping of individual myomas. The efficacy of MRI did not depend on the uterine volume, but TVS efficacy became significantly poorer than that of MRI at volumes of >375 mL. Myoma detection failure rate rose to a significant level for both MRI and TVS with the number of myomas present, but this was particularly outspoken for TVS, except in patients with

Acknowledgements

We thank Professor Niels Jørgen Secher for his guidance, Professor Michael Vaeth for his statistical support, and Morten Pilegård for his help with the manuscript.

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^☆: Reprint requests: Margit Dueholm, MD, Department of Gynecology and Obstetrics, Aarhus University Hospital, DK-8000 Aarhus, Denmark.E-mail: [email protected]

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General Obstetrics and Gynecology: GynecologyAccuracy of magnetic resonance imaging and transvaginal ultrasonography in the diagnosis, mapping, and measurement of uterine myomas☆

Abstract

Section snippets

Patients

Results

Comment

Acknowledgements

Obstet Gynecol

Am J Obstet Gynecol

Magn Reson Imaging

Fertil Steril

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Magn Reson Imaging

Magn Reson Imaging

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Fertil Steril

Am J Obstet Gynecol

A prospective comparison of transabdominal and transvaginal ultrasound with surgical findings in gynecologic disease

J Ultrasound Med

Transvaginal and transabdominal sonography: prospective comparison

Radiology

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AJR Am J Roentgenol

General Obstetrics and Gynecology: Gynecology
Accuracy of magnetic resonance imaging and transvaginal ultrasonography in the diagnosis, mapping, and measurement of uterine myomas☆