Magnetic resonance imaging (MRI) and transvaginal ultrasound for determining fibroid burden: implications for research and clinical care.

Authors: Levens ED, Wesley R, Premkumar A, Blocker W, Nieman LK.

Journal: Am J Obstet Gynecol. 2009 May;200(5):537.e1-7. Epub 2009 Mar 9.

Study performed by: Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, USA.

Problem: The authors want to determine whether MRI or Ultrasound is better at finding fibroids.

Study: 18 women had both an MRI and an ultrasound before they had a hysterectomy. The uterus was then inspected by the pathologist to determine how many fibroids were present and these results were compared to what the MRI and ultrasounds had predicted.

Results: MRI found 80% of the fibroids, while ultrasound found only 40% of the fibroids.

Conclusions: MRI was superior to ultrasound for fibroid assessment.

Dr. Parker’s Comment: This study confirms what other studies have previously shown – that MRI is the best way to “see” fibroids before choosing a treatment or surgery. I find MRI particularly helpful if a patient wants a laparoscopic or robotic myomectomy. By looking at the MRI images myself, I know exactly where all the fibroids are, and whether they can all be removed during surgery. I have also had a number of women who were discovered to have fibroids inside the uterine cavity that were not seen with ultrasound. These women had all been told they needed an abdominal myomectomy or a hysterectomy, but were able to have a hysteroscopic myomectomy, the least invasive procedure with the fastest recovery.

MRI is not always necessary, though. If many fibroids are found with ultrasound and the uterus is very large, usually abdominal myomectomy is going to be the only successful way to take all the fibroids out. So, MRI will add nothing useful because I will be able to feel all the fibroids during surgery and know where they are. Also, if a woman wants to have a laparoscopic hysterectomy, then it is not necessary to know where the individual fibroids are since they will all be removed with the uterus.