quantitative dynamic contrast-enhanced magnetic resonance imaging in symptomatic uterine fibroids and normal uterus: a feasibility study

Background: dynamic contrast enhanced-magnetic resonance imaging (dce-mri) is a relatively new imaging technique that provides additional information on vascularity and permeability of the uterine tissues to improve decision making in patient management. objectives: the purpose of this study was to obtain the quantitative dce-mri parameters of symptomatic uterine fibroids and compare to the parameters obtained from normal myometrium, endometrium, and cervix. patients and methods: nineteen patients (aged 40 ± 5 years) with the clinical diagnosis of uterine fibroids were recruited. after routine mri pelvis scan, dce-mri was performed using t1 volumetric liver acquisition with volume acceleration (lava) sequence. the data were post-processed using an independent dce-mri analysis software. roi was drawn on the fibroid and the quantitative dce-mri parameters i.e. ktrans (volume transfer between the blood plasma and extracellular fluid), kep [flux rate constant between the extracellular extravascular space (ees) and blood plasma], ve (ees fractional volume), and semi-quantitative parameters i.e. ttp (time to peak), and iaugc (initial area under the gadolinium concentration-time curve) were determined. the patients then underwent hysterectomy and uterine fibroids were confirmed in all the patients by histopathology results. in the control group, fifteen healthy volunteers (aged 32 ± 6 years) who did not have uterine fibroid confirmed by sonography examination were recruited. the volunteers underwent the same dce-mri scan as the patients and the quantitative dce-mri parameters of the normal myometrium, endometrium and cervix were obtained. the dce-mri parameters from these two groups were then compared. results: the median ktrans in the myometrium, endometrium and cervix of the healthy volunteers were 0.26 ± 0.13, 0.20 ± 0.15, and 0.30 ± 0.13 min^-1, respectively. no statistical significant difference was found in all the dce-mri parameters between the myometrium, endometrium and cervix of the healthy volunteers. the median k_trans in fibroids was 0.50 ± 0.25 min^-1. there were statistically significant differences (p < 0.05) found in k_trans and ve between the normal myometrium and fibroid tissue. conclusions: the k_trans and ve of fibroid tissue were statistically significantly higher than those obtained from the normal myometrium, whereby the suggested cut-off values were 0.47 min^-1 (sensitivity 64.7%, specificity 92.3%) and 0.62 (sensitivity 70.6%, specificity 78.6%), respectively. quantitative dce-mri findings from this study may provide a foundation for assessment of other uterine pathologies.