Prof Saim Yılmaz, MD
"In uterine fibroids and adenomyosis, treatment must be decided based on MRI"
The value of MRI in fibroids and adenomyosis
MRI is the most valuable diagnostic method for imaging uterine fibroids and adenomyosis. Just like ultrasound, it does not expose radiation and is harmless to pregnant women and children. As mentioned earlier, MRI should be performed in every patient who is thought to have fibroids or adenomyosis and is planned for treatment because:
MRI is the method that shows the number of fibroids most accurately. In many patients who are thought to have one or more fibroids on ultrasound, fibroids can actually be seen to be much more with MRI, and this may change the treatment plan for the patient.
Fibroid size can be measured more accurately and objectively in MRI than in ultrasound. This ensures a more objective treatment plan and follow up for the patient.
The location of fibroids (submucous, intramural, subserous), whether they are stalked or not, and the width of their stalks can be shown much more accurately on MRI than on ultrasound. These data may lead to a change in treatment decision in many patients.
MRI is the method that best displays other diseases that can be confused with fibroids. For example, adenomyosis is often confused with fibroids on ultrasound, whereas it is more easily distinguished by its typical findings on MRI.
Uterine cancer, which can be seen rarely in myoma patients, is also better visualized on MRI.
Ultrasound is not sufficient to show the degree of viability of fibroids. MRI can show very clearly whether fibroids are alive, degenerate (partially alive), or completely dead. For this, MRI examination should be performed with contrast (by giving medication from the arm vein). This feature of MRI is extremely useful in evaluating treatment outcomes after embolization. Before embolization, viable fibroids appear gray/white in color similar to normal uterine tissue on contrast enhanced MRI as they retain contrast. After embolization, these fibroids will shrink and appear black because they can no longer get the contrast. As a result, it can be evaluated objectively whether or not the fibroids have been treated completely.
For these reasons, ultrasound alone should not be considered sufficient for myoma patients. MRI should be performed for every fibroid patient who is considered for treatment, and the treatment decision should always be made by taking into account the MRI findings.
Click for the related video explanation, Prof Dr Saim Yılmaz
The name of the MRI examination that should be ordered in fibroids and adenomyosis is "contrast-enhanced pelvic MRI". This film should be taken by intravenous drug administration, preferably with a powerful MRI device. Open MR devices are generally not strong enough, so they are not preferred, but can be regarded as the second choice in patients who cannot undergo closed MRI. In contrast-enhanced pelvic MRI, 8-10 different shots (sequences) are performed on average. The most useful ones are T2-weighted and contrast-enhanced T1 weighted axial, coronal and sagittal sequences.