Comparison of The Diagnostic Accuracy of Magnetic Resonance Imaging (MRI), Transabdominal Ultrasound (TAS), Transvaginal Ultrasound (TVS) In Characterizing The Uterine Mass Lesions

Introduction: Mass lesions are seen in the uterus in 15 to 20% of women in the reproductive age group. Transabdominal(TAS) ultrasound(USG) is the screening imaging modality of choice. Definitive characterisation of the site, location, endometrial distorsion and number of lesions are important to decide on the treatment Aims and objectives: We compared the sensitivity and specificity of Magnetic resonance Imaging (MRI), TAS, Transvaginal ultrasound (TVS) in detecting and characterizing the uterine mass lesions. Material and methods: We prospectively studied patients with suspected uterine masses .They were subjected to TAS, TVS and MRI examination. Depending upon the final diagnosis they underwent endometrial curettage, cervical biopsy, myomectomy or hysterectomy. Final histopathological report was taken as gold standard to compare the final diagnosis of each imaging modality. Results: The total patients were subgrouped into 5 depending upon the histopathological diagnosis. For detection of myometrial mass lesions, the diagonal agreement between the TVS and MRI is 96%. In classifying the site of myometrial mass lesions, the diagonal agreement between TVS and MRI is 67%. But all tiny submucosal lesions are seen in MRI. For pickingup cystic degeneration within the fibroids TVS and MRI are useful and for calcification TAS or TVS more useful. In positive cases of adenomyosis minimal JZ thickness was 9mm. JZ myometrial ratio was above 23 %. The sensitivity of detecting adenomyosis in TAS, TVS and MRI respectively is 33%, 58% and 92%. In detecting endometrial Ca, MRI is 100% sensitive & 97%. Specific. Prolapsing fundal fibroid with cyst in the pedicle and cervical polyp are diagnosed correctly with MRI. Conclusion: USG is the best screening modality. Calcific degeneration is better identified by TAS and TVS Pelvic MR Imaging compared to TAS and TVS is a well tolerated, non invasive and accurate imaging modality for characterising, localizing and detecting number & extent of uterine mass lesions and for staging