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MR Reproducibility in the Assessment of Uterine Fibroids for Patients Scheduled for Uterine Artery Embolization

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Abstract

Magnetic resonance imaging (MRI) is increasingly applied in the evaluation of uterine fibroids. However, little is known about the reproducibility of MRI in the assessment of uterine fibroids. This study evaluates the inter- and intraobserver variation in the assessment of the uterine fibroids and concomitant adenomyosis in women scheduled for uterine artery embolization (UAE). Forty patients (mean age: 44.5 years) with symptomatic uterine fibroids who were scheduled for UAE underwent T1- and T2-weighted MRI. To study inter- and intraobserver agreement 40 MR images were evaluated independently by two observers and reevaluated by both observers 4 months later. Inter- and intraobserver agreement was calculated using Cohen’s κ statistic and intraclass correlation coefficient for categorical and continuous variables, respectively. Inter-observer agreement for uterine volumes (κ = 0.99, p < 0.0001), dominant fibroid volumes (κ = 0.98, p ≤ 0.0001), and number of fibroids (κ = 0.88; CI, 0.77–0.93; p < 0.0001) was excellent. For the T1- and T2-weighted signal intensity of the dominant fibroid there was good agreement between the observers (87%; 95% CI, 71.9%–95.6%) and the intraobserver agreement was good for observer A (95%; 95% CI, 83.1%–99.4%) and moderate for observer B (κ = 0.47). The interobserver agreement with respect to the presence of adenomyosis was good (κ = 0.73, p < 0.0001), while both intraobserver agreements were fair to moderate (observer A, κ = 0.55, p = 0.0003; and observer B, κ = 0.66, p < 0.0001). In conclusion, MRI criteria used for the selection of suitable UAE patients show good inter- and intraobserver reproducibility.

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Acknowledgments

The EMMY study is funded by ZonMw “Netherlands Organisation for Health Research and Development” (grant application no. 945-01-017) and supported by Boston Scientific Corporation, the Netherlands. We are indebted to all participating patients and EMMY Trial Group members and nurses. We thank M. Nuberg, H. van Welsum, and M. Cornet for their administrative efforts. The members of the EMMY Trial Group were as follows: Initiators—J. Reekers, W. Ankum, and G. Bonsel; Steering Committee—J. Reekers, W. Ankum, M. Burger, G. Bonsel, E. Birnie, G. Veldhuyzen van Zanten, H. van Overhagen, S. de Blok, and H. Vervest; Safety Committee—J. Evers, M. Prins, and J. van Engelshoven, Academic Hospital Maastricht, the Netherlands (nonparticipating center); Data Management and Analysis—W. Hehenkamp, E. Birnie, and N. Volkers; and Executive and Writing Committee—W. Hehenkamp, N. Volkers, E. Birnie, W. Ankum, and J. Reekers. Clinical centers were as follows (number of randomized patients is given in parentheses): Academic Medical Center, Amsterdam (32)—J. Reekers, W. Ankum, M. Burger, G. Bonsel, E. Birnie, W. Hehenkamp, and N. Volkers; Onze Lieve Vrouwe Gasthuis, Amsterdam (40)—S. de Blok and C. de Vries; Atrium Medical Centre, Heerlen (4)—T. Salemans and G. Veldhuyzen van Zanten; Groningen University Hospital, Groningen (3)—D. Tinga and T. Prins; Bosch Medical Centre, Den Bosch (1)—P. Sluijffers and M. Rutten; Bronovo Hospital, The Hague (1)—M. Smeets and N. Aarts; Medical Centre Rijnmond-Zuid, Rotterdam (2)—P. van der Moer and D. Vroegindeweij; St. Elisabeth Hospital, Tilburg (6)—F. Boekkooi and L. Lampmann; Flevo Hospital , Almere—G. Kleiverda; Gooi-Noord Hospital, Laren—R. Dik and J. Marsman; Kennemer Gasthuis, Haarlem (4)—C. de Nooijer , I. Hendriks, and G. Guit; Leyenburg Hospital, The Hague (4)—H. Ottervanger and H. van Overhagen; St. Lucas/Andreas Hospital, Amsterdam (4)—A. Thurkow; Martini Hospital, Groningen (10)—P. Donderwinkel, J. Wijma, and C. Holt; Medical Centre Alkmaar, Alkmaar (4)—A. Adriaanse and J. Wallis; Medical Centre Leeuwarden, Leeuwarden (9)—J. Hirdes, J. Schutte, and W. de Rhoter; Hospital Midden-Twente, Hengelo (6)—P. Paaymans and R. Schepers-Bok; Medisch Spectrum Twente, Enschede (5)—G. van Doorn, J. Krabbe, and A. Huisman; Reinier de Graaf Gasthuis, Delft (2)—M. Hermans and R. Dallinga; Slingeland Hospital, Doetichem (4)—F. Reijnders and J. Spithoven; St. Jans Gasthuis, Weert (1)—W. de Jager and P. Veekmans; Twenteborg Hospital, Almelo (6)—P. van der Heijden, M. Veereschild, and J. van den Hout; University Medical Centre Utrecht, Utrecht (4)—I. van Seumeren, A. Heintz, R. Lo, and W. Mali; Westeinde Hospital, The Hague (2)—J. Lind and Th. de Rooy; Diakonessenhuis Utrecht, Utrecht (5)—M. Bulstra and F. Sanders; De Heel Hospital, Zaandam (1)—J. Doornbos; Rijnstate Hospital, Arnhem (3)—P. Dijkhuizen and M. van Kints; Slotervaart Hospital, Amsterdam (4)—Ph. Engelen and R. Heijboer; and BovenIJ Hospital, Amsterdam (5)—A. Dijkman.

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Authors and Affiliations

  1. Department of Radiology, Academic Medical Centre, G1-235, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands

    Nicole A. Volkers, Anje M. Spijkerboer & Jim A. Reekers

  2. Department of Gynaecology, 1105, AZ, Amsterdam, The Netherlands

    Wouter J. K. Hehenkamp & Willem M. Ankum

  3. Department of Radiology, Waterland Hospital, Purmerend, The Netherlands

    Albert D. Moolhuijzen

  4. Academic Medical Centre, Department of Public Health Epidemiology, Amsterdam, and Erasmus Medical Centre, Institute of Health Policy and Management, Rotterdam, The Netherlands

    Erwin Birnie

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  1. Nicole A. Volkers
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  6. Willem M. Ankum
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Correspondence to Nicole A. Volkers.

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Volkers, N.A., Hehenkamp, W.J.K., Spijkerboer, A.M. et al. MR Reproducibility in the Assessment of Uterine Fibroids for Patients Scheduled for Uterine Artery Embolization. Cardiovasc Intervent Radiol 31, 260–268 (2008). https://doi.org/10.1007/s00270-007-9209-0

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