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.