Doppler sonography of perifibroid and intrafibroid arteries of uterine leiomyomas

Abstract

ObjectiveTo sonographically evaluate the dominant fibroid nodule vascularity and flow velocity pattern of perifibroid and intrafibroid arteries.MethodsWe recruited 140 women with uterine fibroids. Their uteri were scanned to determine the vascularity of fibroid nodules and the Doppler indices of the fibroid arteries.ResultsThe median volume of the dominant leiomyoma nodule was 133 cm3 (range=1.5–2,575 cm3). Eighty-three subjects (59.3%) had a dominant leiomyoma nodule volume of ≤200.0 cm3 while the volume of the dominant leiomyoma nodule was >200.0 cm3 in 57 (40.7%) subjects. The dominant fibroid nodule was vascular in 137 (97.9%) subjects and avascular in 3 (2.1%). All the perifibroid artery indices (except the end-diastolic velocity [EDV] and diastolic average ratio [DAR]) are significantly higher than those of the intrafibroid artery. The mean Doppler indices of perifibroid vs. intrafibroid arteries as follows: peak systolic velocity (PSV; 52.1 vs. 45.4 cm/s); EDV (21.1 vs. 22.4 cm/s); time-averaged maximum velocity (TAMX; 31.5 vs. 30.4 cm/s); time- averaged mean velocity (Tmean; 14.3 vs. 13.8 cm/s); pulsatility index (PI; 1.1 vs. 0.8); resistive index (RI; 0.6 vs. 0.5); systolic-diastolic ratio (SDR; 2.7 vs. 2.1); impedance index (ImI; 2.7 vs. 2.1); and DAR (0.66 vs. 0.74); P<0.001 for all indices.ConclusionThe predominant pattern of fibroid vascularity is peripheral vascularity and the perifibroid artery indices (except EDV and DAR) are significantly higher than those of the intrafibroid artery. Recurrent fibroids in women with previous myomectomy had significantly higher intrafibroid PI, RI, SDR, and ImI than those without previous myomectomy.

Efficacy of magnetic resonance imaging-guided focused ultrasound ablation of uterine fibroids in reproductive-age patients with symptomatic uterine fibroids

“…Цветовое допплеровское картирование и допплерометрия при проведении УЗИ позволяют оценить качественные и количественные параметры кровотока в узле миомы матки, что позволяет предположить гистотип миомы матки [7][8][9].…”

“…Метод МРТ имеет 100% специфичность, 97% точность и чувствительность в диапазоне 86-92% и является дополнительным, уточняющим методом исследования в диагностике миомы матки. Кроме того, МРТ помогает в оценке анато- [7,12,13]. Наиболее важным вопросом для клинициста является дифференцированный выбор лечебной тактики у пациенток репродуктивного возраста с симптомной миомой матки в аспекте возможной реализации репродуктивных планов.…”

The Importance of the Study of the Hemodynamics of the Uterine Tumors by the Method of Dopplerometry in the Two- And Three-Dimensional Echography Modes for Differential Diagnostics of Simple, Proliferating Leiomyomas and Uterine Sarcomas

“…In the future, in the world, a large number (count goes to thousands) of rather controversial results on the study of hemodynamics of simple, proliferating leiomyomas and sarcomas of the uterus was carried out, using two-dimensional dopplerometry to search for possible differential diagnostic criteria. One part of the authors considers the method to be informative; other researchers do not find reliable ultrasound differences between the blood flow in leiomyomas and uterine sarcomas [11,12]. Thus, in a two-dimensional ultrasound with dopplerometry before surgery, a morphologically verified diagnosis of uterine leiomyosarcoma was established in studies in only 13.8 % of cases [13], and according to other studies, the uterine body leiomyosarcoma at the preoperative stage was diagnosed in 68.8-70.8 % of cases of echography [5,14 ].…”

“…Based on the analysis of the published data of the part of the studies whose authors consider the method of dopplerometry in the two-dimensional mode to be informative for the diagnosis of benign, borderline and malignant myometrium tumors, general differential diagnostic markers were identified: the localization of the detected vessels in the CDM regimen and the rate of vascular blood flow, vascular resistance in the pulsed Doppler mode [1,12]. For a simple leiomyoma, the absence of a central intra-node localization of blood vessels in the CDM regimen, a low rate of arterial and venous blood flow, as well as an average resistance of arterial blood flow in the regime of impulsive dopplerometry are most typical; in a leiomyoma with eating disorders, the absence of a central intra-node localization of blood vessels, a low rate of arterial and venous blood flow in combination with high arterial resistance were observed more often [3,6].…”

“…Analysis of numerous publications on the evaluation of blood flow in the uterine arteries by the method of two-dimensional impulse-wave Doppler ultrasound in the ultrasonic differential diagnosis of benign and malignant tumors of the uterus has shown that it has not been finally solved [21,22]. Many authors tend to believe that this technique is characterized by high sensitivity, but very low specificity [23,24], since a decrease in the index of uterine artery resistance is observed, both with leiomyoma and with uterine sarcoma [11,12].…”