Visualisation of microvascular flow in benign uterine disorders: a pilot study of a new diagnostic technique

Marissa Frijlingh, M Frijlingh, R A de Leeuw, Robert A. de Leeuw, L J M Juffermans, Lynda J.M. Juffermans, T van den Bosch, Judith A.F. Huirne, J A F Huirne
Facts, views & vision in ObGyn · 2023 · vol. 15(2) , pp. 115–122 · doi:10.52054/fvvo.15.2.072 · PMID:37436047 · PMC10410655 · W4383683486
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This pilot study demonstrates that microvascular flow imaging can visualize uterine microvasculature in benign disorders, providing detailed images and easily calculable vascular indices for fibroids.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-08 · read from full text ⓘ

This pilot study tested the feasibility of a new microvascular flow imaging mode (MV-flowTM) to visualize uterine microvascular architecture in benign uterine disorders, compared with standard power Doppler during outpatient ultrasound. Across two gynecologists and ten patients per clinician (with eight patients labeled by attending physicians), the investigators collected images of normal uterine architecture and benign conditions including fibroids, adenomyosis, endometriosis, and uterine niches, and assessed vascular architecture qualitatively plus a quantitative vascular index for fibroids. Microvascular flow imaging produced more distinctive vascular structures than power Doppler, with fibroid vascular index calculations feasible on-site, and it showed higher vascular index values in systole versus diastole. The paper’s main limitation is that it is a feasibility pilot without validation against histology and clinical outcomes. Relevance to endometriosis: the study explicitly includes endometriosis among the benign disorders imaged using MV-flowTM for microvascular architecture visualization.

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Abstract

Background: Uterine disorders have clear overlapping symptoms and ultrasound discrimination is not always easy. Accurately measuring vascularity is of diagnostic and prognostic value. Power Doppler is limited to imaging only the larger vessels. Assessment of the microvasculature requires advanced machine settings. Objectives: In this pilot study, we aimed to test the feasibility of microvascular flow imaging of benign uterine disorders. Material and Methods: Two experienced gynaecologists (JH, RL) randomly applied power Doppler and MV-flowTM mode during a single day, in ten patients each visiting the outpatient clinic. Images of eight patients were labelled with a diagnosis by the attending physicians and collected as coded data. Main outcome measures: Microvascular flow images of normal uterine architecture including the fallopian tube, and of benign disorders such as fibroids, adenomyosis, endometriosis and uterine niches were collected. For both Doppler techniques, qualitative descriptive evaluation of the vascular architecture and a quantitative vascular index of fibroids were provided. Finally, we evaluated the effect of the cardiac cycle. Results: All microvascular flow images showed more distinctive vascular structures than visible on power Doppler. Calculating a vascular index for fibroids on 2D MV-flowTM images was easily performed on-site. During the cardiac cycle a higher vascular index (VI 75.2) is obtained in systole as compared with diastole (VI 44.0). Conclusion: Microvascular flow imaging allowed detailed visualisation of the uterine vascular architecture and is easy to use. What is new?: Microvascular flow imaging may be of added value for diagnosing uterine disorders, as well as for pre- and post-operative assessment of suited surgical techniques. Yet, validation with histology and clinical outcomes is required.
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Abstract

Background Uterine disorders have clear overlapping symptoms and ultrasound discrimination is not always easy. Accurately measuring vascularity is of diagnostic and prognostic value. Power Doppler is limited to imaging only the larger vessels. Assessment of the microvasculature requires advanced machine settings.

Objectives

In this pilot study, we aimed to test the feasibility of microvascular flow imaging of benign uterine disorders.

Material and methods

Two experienced gynaecologists (JH, RL) randomly applied power Doppler and MV-flowTM mode during a single day, in ten patients each visiting the outpatient clinic. Images of eight patients were labelled with a diagnosis by the attending physicians and collected as coded data. Main outcome measures Microvascular flow images of normal uterine architecture including the fallopian tube, and of benign disorders such as fibroids, adenomyosis, endometriosis and uterine niches were collected. For both Doppler techniques, qualitative descriptive evaluation of the vascular architecture and a quantitative vascular index of fibroids were provided. Finally, we evaluated the effect of the cardiac cycle.

Results

All microvascular flow images showed more distinctive vascular structures than visible on power Doppler. Calculating a vascular index for fibroids on 2D MV-flowTM images was easily performed on-site. During the cardiac cycle a higher vascular index (VI 75.2) is obtained in systole as compared with diastole (VI 44.0).

Conclusion

Microvascular flow imaging allowed detailed visualisation of the uterine vascular architecture and is easy to use. What is new? Microvascular flow imaging may be of added value for diagnosing uterine disorders, as well as for pre- and post-operative assessment of suited surgical techniques. Yet, validation with histology and clinical outcomes is required.

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endometriosisadenomyosis

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