Evaluation of the routine use of pelvic MRI in women presenting with symptomatic uterine fibroids: When is pelvic MRI useful?

Abstract

Background Pelvic ultrasound (US) diagnosis of uterine fibroids may overlook coexisting gynecological conditions that contribute to women's symptoms. Purpose 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. Study Type Retrospective observational study. Population 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 T2‐weighted sequences, and precontrast and postcontrast T1‐weighted imaging. Assessment Demographics, symptoms, uterine fibroid symptom severity scores, and health‐related quality of life scores, as well as imaging findings were evaluated. Statistical Tests Patients were separated into two subgroups according to whether MRI provided additional findings to the initial US. Univariate and multivariate regression analyses were performed. Results 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). Data Conclusion 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. Level of Evidence: 4 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2019.