Functional and Multi-parametric Imaging of Uterine Fibroids: Current Advances and Clinical Applications

Background: Uterine fibroids are the most common benign tumours of the uterus and often require accurate diagnosis and individualised management. However, traditional imaging techniques such as ultrasound and CT have limitations in detecting complex fibroid morphology, assessing vascularity, and differentiating fibroids from other uterine pathologies, such as adenomyosis or malignancy. The objective is to evaluate and summarise the current advances in functional and multi-parametric imaging modalities for uterine fibroids, and highlight their clinical applications in diagnosis, treatment planning, image-guided intervention, and follow-up. Material and Methods: A systematic literature search was conducted across PubMed, Scopus, Embase, and Web of Science databases for English-language studies published between January 2015 and May 2025. Inclusion criteria comprised human studies evaluating functional imaging modalities, including diffusion-weighted imaging (DWI), dynamic contrast-enhanced MRI (DCE-MRI), elastography, contrast-enhanced ultrasound (CEUS), radiomics, and PET-MRI, in fibroid management. Case reports, reviews, and animal studies were excluded. A narrative synthesis of eligible studies was performed due to methodological heterogeneity. Results: Recent studies demonstrate that multi-parametric imaging offers significant advantages in characterising fibroids, predicting response to minimally invasive therapies (e.g., UAE and MRgFUS), and monitoring treatment outcomes. Parameters such as T2 signal intensity, ADC values, vascular perfusion patterns, stiffness metrics, and radiomic signatures provide quantitative, reproducible markers that improve diagnostic accuracy and guide personalised care. Conclusion: Functional and multi-parametric imaging has transformed fibroid management from a structural, symptom-based approach to one guided by tissue-specific insights. Its integration into clinical practice, supported by standardisation and prospective multicenter validation, holds the potential to improve patient outcomes and reduce unnecessary interventions. Keywords: Uterine fibroids; multiparametric imaging; functional MRI; CEUS; elastography; radiomics.