Prof Saim Yılmaz, MD
"All fibroid patients should undergo a pelvic MRI before the treatment"
Why Should All Myoma Patients Have an MRI (Magnetic Resonance Imaging)?
Before deciding on the best treatment option, all patients with fibroids (myomas) should get a pelvic MRI taken and the treatment should be chosen based on the "Contrast-enhanced pelvic MR" findings. Because:
1. 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.
2. Fibroid size can be measured more accurately and objectively in MRI than in ultrasound. This may effect the treatment decision about the patient.
3. 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 in MRI than in ultrasound. These data may lead to a change in treatment decision in many patients.
4. 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 appreciated on MRI.
5. 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 evaluation, 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. In contrast-enhanced MRI, viable fibroids appear gray/white in color similar to uterine tissue, as they retain contrast prior to embolization. After embolization, these fibroids shrink and appear dark black because they can no longer hold the drug. Thus, it can be readily appreciated whether or not the fibroids in the uterus are dead on MRI control after embolization.
For these reasons, ultrasound alone is not sufficient in myoma patients. MRI should be performed in every fibroid patient who is considered for treatment, and the treatment decision should be made by taking into account the MRI findings.
