CINE MRI During Spontaneous Cramps in Women with Menstrual Pain [7Q

Abstract

INTRODUCTION: Prior research has suggested that changes in the MR signal occur in the myometrial layer in women with dysmenorrhea. Since the mechanisms of dysmenorrhea are poorly understood, characterization of the relationship between MR signal changes and spontaneous pain report would be useful for developing a diagnostic tool. METHODS: This was an IRB-approved HIPAA-compliant prospective feasibility study during 2015-2017 on 16 women with dysmenorrhea and 10 healthy controls both on and off their menses while not taking analgesic medication. Continuous MRI was acquired using single HASTE sequence along with simultaneous reporting of pain severity with a squeeze bulb. The temporal relationships of signal changes were evaluated with Pearson correlations, image averaging, and statistical comparison to a random temporal distribution. RESULTS: Spontaneous progressive decreases in myometrial signal intensity were more frequently observed in women on their menses than in the same women off their menses or participants without dysmenorrhea (p’s < 0.01). Women without reductions in myometrial signal intensity on their menses either had a history of endometriosis or were not in pain. Episodes of cramping occurred either immediately before or 32-70s after myometrial signal change onset (p’s <0.05). CONCLUSION: The combination of early and delayed subjective pain report - relative to a decrease in T2 weighted signal intensity – provides new evidence supportive of a contribution of myometrial activity and impaired hemodynamics to menstrual pain. The proposed approach will allow future studies to evaluate effects of interventions for uterine pain disorders and test mechanistic hypotheses about the etiology of visceral pain.