Technical Accuracy and Efficiency of Magnetic Resonance Imaging in Evaluation of Uterine Masses in Comparison with Ultrasound Using Histopathology as a Gold Standard
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Abstract Introduction: uterine masses represent a very common problem amongst the females. Uterine leiomyoma, adenomyosis, carcinoma of the cervix and the uterus and the endometrial pathology, which include the carcinoma and polyp are the most common of them. The Ultrasound (USG) and Magnetic Resonance Imaging (MRI) appear as significant modalities for the diagnosis of the pathologies of the uterine. Definitive characterization of the location, endometrial distortion and number of masses are important to decide on the treatment. Aim of the study: To compare the accuracy; sensitivity and specificity of the magnetic resonance imaging and ultrasound in differentiation and characterization of the uterine masses. Patients and Methods: An ethically approved prospective study was done upon 40 patients with suspected uterine masses at Institute of X-ray and Oncology Teaching Hospital/ Medical City- Baghdad. All included patients underwent Ultrasound (USG) and magnetic resonance imaging (MRI) and were accordingly treated surgically. Histopathology report was traced postoperatively. Data was collected and subjected to various statistical tests including Cohen’s kappa. Results: Among 40 female patients, majority were diagnosed as leiomyoma 23 (57.5%), cervical cancer 1 (2.5%), adenomyosis 12 (30%), endometrial polyp 2 (5%) and endometrial carcinoma 2 (5%). Totally 3 (7.5%) patients have been found malignant while 37 (92.5%) have been found benign. For detection of myometrial mass (leiomyoma), the sensitivity between the ultrasound and MRI is 100%, accuracy was (ultrasound: 85% and MRI: 98%). In the classification of myometrial mass (leiomyoma) location, sensitivity between the ultrasound and MRI has been 26% and 96% respectively and specificity was (ultrasound: 0 and MRI: 83%). All intramural and subserosal lesions are seen in MRI. For picking up degeneration within the leiomyoma MRI are more useful. There have been considerable differences in the diagnosis of the adenomyosis by the MRI in comparison with ultrasound with sensitivity was (MRI: 58% and ultrasound: 92%), and specificity for both was 100%, whereas accuracy was 87% for ultrasound and 98% for MRI. In the detection of the endometrial carcinoma, the MRI has achieved 100% sensitivity and 97% specificity whereas ultrasound had zero sensitivity and specificity was 97%. Among two cases of endometrial polyp, one patient is diagnosed correctly by ultrasound & MRI, the sensitivity for both was 50% and accuracy was (ultrasound: 95% and MRI: 98%). MRI and ultrasound was correctly diagnosis of one patient with cervical cancer with sensitivity and accuracy 100%. Conclusion: Ultrasound is a good screening modality, but MRI is definitely better for proper characterization and localization of uterine masses enabling clinicians to select the most appropriate management in everyday clinical practice.

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