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. K-trans (volume transfer between the blood plasma and extracellular fluid), K-ep [flux rate constant between the extracellular extravascular space (EES) and blood plasma], V-e (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 K-trans 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 V-e between the normal myometrium and fibroid tissue. Conclusions: The K-trans and V-e 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.