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Uterine fibroids: correlations between MRI appearance and stiffness via magnetic resonance elastography

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Abstract

Rationale and objectives

Magnetic resonance elastography has proven to be a valuable tool in the diagnosis of liver fibrosis, breast and cervical cancer, but its application in uterine fibroids requires further characterization. The aim of the present study was to examine the relationship between uterine fibroid stiffness by MRE and MR imaging characteristics.

Materials and methods

An IRB-approved, HIPAA compliant review was performed of prospectively collected pelvic MRI and 2D-MRE data in patients with symptomatic uterine fibroids (N = 102). T1 and T2 weighted pelvic MRI with gadolinium enhancement were performed. In a small patient subset, fibroid stiffness was assessed by both 2D and 3D MRE. Fibroid stiffness by modality or imaging characteristics was analyzed using one-way analysis of variance followed by Student t test.

Results

Four fibroid groups were identified based on T2 appearance: Isointense (N = 7), bright (N = 6), dark with minimal heterogeneity (N = 69), and dark with substantial heterogeneity (N = 20). Mean fibroid stiffness was 4.81 ± 2.12 kPa. Comparison of fibroid stiffness by T2 signal intensity showed that T2 bright fibroids were significantly less stiff than fibroids appearing T2 dark with minimal heterogeneity (mean stiffness difference = 2.38 kPa; p < 0.05) and T2 dark fibroids with substantial heterogeneity were significantly less stiff than T2 dark fibroids with minimal heterogeneity (mean difference = 1.25 kPa; p < 0.05). There was no significant association between fibroid stiffness and T1 signal characteristics or gadolinium enhancement. There was no significant difference in stiffness values obtained by either 2D vs. 3D MRE.

Conclusions

These data suggest differences in fibroid stiffness are associated with different T2 imaging characteristics with less stiff fibroids being T2 bright and more stiff fibroids being T2 dark. Further studies are needed to determine if fibroid stiffness by MRE may serve as an imaging biomarker to help predict MR-guided treatment response.

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Authors and Affiliations

  1. Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Danielle E. Jondal, Jin Wang, Jun Chen, Krzysztof R. Gorny, Joel Felmlee, Gina Hesly, Richard Ehman & David A. Woodrum

  2. Department of Obstetrics and Gynecology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Shannon Laughlin-Tommaso & Elizabeth A. Stewart

Authors
  1. Danielle E. Jondal
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  2. Jin Wang
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  3. Jun Chen
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  4. Krzysztof R. Gorny
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  5. Joel Felmlee
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  8. Elizabeth A. Stewart
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  9. Richard Ehman
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Corresponding author

Correspondence to David A. Woodrum.

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Conflict of interest

Danielle E. Jondal, Jin Wang, Jun Chen, Krzysztof R. Gorny, Joel Felmlee and Richard Ehman have nothing to disclose. Gina Hesly reports grants from Insightec, outside the submitted work. Shannon Laughlin-Tommaso reports grants from InSightec Ltd (Israel), outside the submitted work. Elizabeth A. Stewart is supported by RC1HD063312 and R01HD060503 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health. Elizabeth A. Stewart also reports personal fees from AbbVie, personal fees from Bayer, personal fees from GlaxoSmithKline, personal fees from Gynesonics, personal fees from Astellas Pharmaceuticals, personal fees from Welltwigs, personal fees from Viteava Pharmaceuticals, and personal fees from Allergan, outside the submitted work; In addition, Elizabeth A. Stewart has a patent Methods and Compounds for Treatment of Abnormal Uterine Bleeding. US 6440445 issued to none. David A. Woodrum has an NIH grant, “Regulation of molecular thermal ablative resistance in hepatocellular carcinoma. Funded by National Cancer Institute. (R01 CA 177686).” Personnel funded by this grant helped with the manuscript.

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Jondal, D.E., Wang, J., Chen, J. et al. Uterine fibroids: correlations between MRI appearance and stiffness via magnetic resonance elastography. Abdom Radiol 43, 1456–1463 (2018). https://doi.org/10.1007/s00261-017-1314-1

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  • DOI: https://doi.org/10.1007/s00261-017-1314-1

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