MR Evaluation of Uterine Mass Lesions in Correlation with Transabdominal, Transvaginal Ultrasound Using HPE as a Gold Standard.

Mass Lesions In The Uterus Are A Commonly Encountered Problem All Over The World. 15 To 20% Of Women In The Reproductive Age Group Have Mass Lesions In The Uterus38. In The Institute Of Obstetrics And Gynaecology, Egmore, Chennai, About 800 Hysterectomies Were Done For Benign Pathology In The Year 2004. Among Them 45% Had Fibroid Uterus And 25% Had Adenomyosis. But Less Than 5% Of Total Adenomyosis Cases Were Diagnosed By Transabdominal Ultrasound Alone Preoperatively. This Necessitated The Definitive Preoperative Diagnosis Of Adenomyosis. Over The Years Many Imaging Modalities Like Transabdominal Ultrasound, Transvaginal Ultrasound, Colour Doppler, Hysterosonosalphingography, Computerised Tomography, Magnetic Resonance Imaging Have Been Tried To Characterise The Mass Lesions. Even Today Transabdominal Ultrasound Is The Screening Imaging Modality Of Choice. Definitive Characterisation Of The Lesion Is Important To Decide On The Treatment Modality. For Example, In Case Of Myoma, Myomectomy Or Hysterectomy Can Be Done. But In Case Of Adenomyosis, Hysterectomy Is The Treatment Of Choice For Definitive Cure38,18. This States The Need For A Definitive Preoperative Diagnosis. In Cases Of Submucosal Fibroid, If The Endometrial Surface Circumference Is More Than 50% It Can Be Resected Hysteroscopically18. Otherwise It Should Be Resected Laparoscopically. The Same Way For Intramural Fibroids, Depending On The Number And Site Of The Lesion, Laparoscopic Resection Or Hysterectomy Can Be Planned. It States The Need For Exact Location And Extent Of The Lesion By Various Measurements Like Size And Circumference. To Some Extent The Questions Were Answered By Transvaginal Ultrasound But It Depends On The Operator And Large Lesions Cannot Be Brought Within The Field Of Transvaginal Ultrasound. Hysterosonosalphingography Is Useful Only In Endometrial Lesions. CT Is Utilized To Evaluate Uterine Lesion Mainly In Staging The Carcinomas. The Continuing Need For Better Imaging Modality For Definitive Characterisation Of Uterine Mass Lesions Lead To The Use Of MRI As A Diagnostic Tool In Preoperative Evaluations. MRI Is A Recently Devised Modality Which Is Done In Sagittal, Axial And Coronal Planes Using Body Surface Coil In T1, T2 Weighted Sequences. This Study Involves Detailed Evaluation Of Uterine Mass Lesions Like Number, Location, Size, Other Measurements, Degenerative Changes Within The Lesions, Extent Of The Lesion Using Transabdominal Ultrasound, Transvaginal Ultrasound & MRI. Final Diagnosis By Imaging Was Compared With Histopathological Reports. Comparisons Were Made Between The Three Modalities For 1. Detection Sensitivity Of Each Parameter, 2. Characterisation & Differentiation Between Lesions, 3. Sensitivity & Specificity Of Each Modality To Make Final Diagnosis Against HPE Reports.