Evaluation of Uterine Fibroid Vascularity Using Contrast-Enhanced Ultrasound in Comparison with Contrast-Enhanced Magnetic Resonance Imaging

Abstract

ObjectiveTo assess uterine fibroid vascularity using contrast-enhanced ultrasound (CEUS) comparing these findings with magnetic resonance imaging (MRI). MethodsForty women diagnosed with symptomatic uterine fibroids scheduled for uterine artery embolization (UAE) were enrolled in this IRB-approved study. Subjects underwent CEUS examination prior to UAE using an Aplio i800 scanner (Canon Medical Systems, Tustin, CA, USA) with curvilinear array (8C1). CEUS was performed using 2.0ml of the ultrasound contrast agent, Lumason (Bracco, Milan, Italy) administered intravenously. Digital CEUS clips were acquired, randomized off-line and fibroids were characterized hyper- or hypovascular. MRI was used as reference standard for fibroid vascularity and compared to CEUS. Results were analyzed using McNemar's test. ResultsForty subjects were enrolled in the trial. One patient did not proceed with the UAE procedure and one patient refused pre-procedure MRI due to claustrophobia. Therefore, 38 subjects underwent CEUS and MRI examinations prior to UAE. Hypervascular fibroids were seen on MRI and CEUS in 24 and 26 subjects, respectively. Hypovascular fibroids were seen with MRI and CEUS in 14 and 12 subjects, respectively. Fibroids characterized as hypovascular in two subjects by MRI were characterized as hypervascular by CEUS. CEUS and MRI findings were similar in 36/38 subjects corresponding to an accuracy of 95% (p = 0.62). ConclusionCEUS can accurately assess uterine fibroid vascularity serving as a potential alternative to MRI to determine vascularity of uterine fibroids.