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Use of multiparametric MRI to characterize uterine fibroid tissue types



Although the biological characteristics of uterine fibroids (UF) have implications for therapy choice and effectiveness, there is limited MRI data about these characteristics. Currently, the Funaki classification and Scaled Signal Intensity (SSI) are used to predict treatment outcome but both screening-tools appear to be suboptimal. Therefore, multiparametric and quantitative MRI was studied to evaluate various biological characteristics of UF.


87 patients with UF underwent an MRI-examination. Differences between UF tissues and myometrium were investigated using T2-mapping, Apparent Diffusion Coefficient (ADC) maps with different b-value combinations, contrast-enhanced T1-weighted and T2-weighted imaging. Additionally, the Funaki classification and SSI were calculated.


Significant differences between myometrium and UF tissue in T2-mapping (p = 0.001), long-TE ADC low b-values (p = 0.002), ADC all b-values (p < 0.001) and high b-values (p < 0.001) were found. Significant differences between Funaki type 3 versus type 1 and 2 were observed in SSI (p < 0.001) and T2-values (p < 0.001). Significant correlations were found between SSI and T2-mapping (p < 0.001; ρs = 0.82), ADC all b-values (p = 0.004; ρs = 0.31), ADC high b-values (p < 0.001; ρs = 0.44) and long-TE ADC low b-values (p = 0.004; ρs = 0.31).


Quantitative MR-data allowed us to distinguish UF tissue from myometrium and to discriminate different UF tissue types and may, therefore, be a useful tool to predict treatment outcome/determine optimal treatment modality.

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Apparent diffusion coefficient


Diffusion-weighted imaging


Magnetic resonance image guided-high intensity focused ultrasound


Magnetic resonance imaging


Non-perfused volume


Signal intensity


Scaled signal intensity


Echo time


Transformed symptom severity score


Transformed health-related quality of life


Uterine artery embolization


Uterine fibroid symptom health-related quality of life questionnaire


Uterine fibroids


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This research was made possible with financial support from the Innovation and Science fund of Isala Hospital in Zwolle, the Netherlands.

Author information




IV contributed to the study design, in the acquisition of data and data analysis, interpretation of data and writing of the manuscript. KJ had a substantial contribution in the acquisition of data, data analysis, interpretation of data and writing of the manuscript. EH had a substantial contribution to the study design, implementing the MRI study protocol and interpretation of the data. ME, PC and IN were involved in the analysis and the interpretation of data. JD and JS had major contributions to this study by including the study participants and facilitating the collection of data. LB, CM and AF were involved in the interpretation of data and drafting the manuscript. MB was the principal investigator of this study and responsible for the conceptual design of the study, obtaining ethical approval and interpretation of the data. All authors critically revised the manuscript for important intellectual content and approved the final manuscript.

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Correspondence to Inez M. Verpalen.

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Conflict of interest

Authors E. Heijman and P.C. Vos are both employees of Philips who have developed the MR-HIFU equipment. All other authors had no financial interest or conflicts of interest in the subject matter discussed in the submitted manuscript. All authors state that this study complies with the Declaration of Helsinki.

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All authors state that this study complies with the Declaration of Helsinki.

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Verpalen, I.M., Anneveldt, K.J., Vos, P.C. et al. Use of multiparametric MRI to characterize uterine fibroid tissue types. Magn Reson Mater Phy 33, 689–700 (2020).

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  • Uterine fibroids
  • High-intensity focused ultrasound ablation
  • Magnetic resonance imaging
  • Diffusion MRI