The True Fibroid Map: Correlating Preoperative MRI and Intraoperative Findings

Abstract

Study Objective To evaluate and compare the accuracy of Magnetic Resonance Imaging (MRI) in myoma diagnosis and mapping and its correlation with intraoperative findings. Design All patients with symptomatic leiomyoma attending the centre of study (Centre for minimally invasive Gynaecology, Obstetrics and ART, Paras Hospital, India) from August 2018-June 2020 underwent MRI and were subsequently operated at the same centre were considered for inclusion. The MRI was reviewed for number of fibroids, size, location, type and FIGO class of the largest fibroid and the same was correlated with intraoperative findings. Setting N/A. Patients or Participants 42 women with a diagnosis of symptomatic leiomyoma and meeting the inclusion criteria were enrolled. Interventions Laparoscopic myomectomy, Hysteroscopic myomectomy, Total laparoscopic hysterectomy, Abdominal myomectomy. Measurements and Main Results Of 42 patients enrolled, the number of fibroids predicted by MRI corroborated with intraoperative findings in 26 patients, 15 patients had greater number of fibroids during surgery and 1 had less than that predicted (median fibroid on MRI=2.0, median number in surgery=2.0, p=0.001). Location of largest fibroid predicted by MRI correlated with intraoperative findings in 77.8% anterior wall, 90% posterior wall, 83.3% left lateral wall and in 81.8% of fundal fibroids (k=0.757, p<0.001). MRI could accurately predict the type of fibroid in 80% submucosal, 87.5% intramural and 66.7% subserosal variants (k=0.642, p<0.001). FIGO class of largest fibroid denoted by MRI showed good correlation with intraoperative findings (k=0.670, p<0.001). Size of largest fibroid predicted by MRI (median=58.5cm2) correlated well with size measured during surgery (median= 60cm2, k=0.819). Conclusion MRI is an efficient tool for mapping of fibroid location, type and FIGO class but falls short in identifying the exact number of fibroids that can be encountered during surgery particulary in patients with larger uteri (> 12-week size) or multiple myomas (>5 in number). To evaluate and compare the accuracy of Magnetic Resonance Imaging (MRI) in myoma diagnosis and mapping and its correlation with intraoperative findings. All patients with symptomatic leiomyoma attending the centre of study (Centre for minimally invasive Gynaecology, Obstetrics and ART, Paras Hospital, India) from August 2018-June 2020 underwent MRI and were subsequently operated at the same centre were considered for inclusion. The MRI was reviewed for number of fibroids, size, location, type and FIGO class of the largest fibroid and the same was correlated with intraoperative findings. N/A. 42 women with a diagnosis of symptomatic leiomyoma and meeting the inclusion criteria were enrolled. Laparoscopic myomectomy, Hysteroscopic myomectomy, Total laparoscopic hysterectomy, Abdominal myomectomy. Of 42 patients enrolled, the number of fibroids predicted by MRI corroborated with intraoperative findings in 26 patients, 15 patients had greater number of fibroids during surgery and 1 had less than that predicted (median fibroid on MRI=2.0, median number in surgery=2.0, p=0.001). Location of largest fibroid predicted by MRI correlated with intraoperative findings in 77.8% anterior wall, 90% posterior wall, 83.3% left lateral wall and in 81.8% of fundal fibroids (k=0.757, p<0.001). MRI could accurately predict the type of fibroid in 80% submucosal, 87.5% intramural and 66.7% subserosal variants (k=0.642, p<0.001). FIGO class of largest fibroid denoted by MRI showed good correlation with intraoperative findings (k=0.670, p<0.001). Size of largest fibroid predicted by MRI (median=58.5cm2) correlated well with size measured during surgery (median= 60cm2, k=0.819). MRI is an efficient tool for mapping of fibroid location, type and FIGO class but falls short in identifying the exact number of fibroids that can be encountered during surgery particulary in patients with larger uteri (> 12-week size) or multiple myomas (>5 in number).