Prior to the consultation for symptomatic uterine fibroids with Dr. Lipman, patients will undergo a pelvic MRI. The imaging findings will be correlated to your symptoms to determine the best treatment recommendation.
Some patients wonder why they need to undergo a pelvic MRI when they have had a pelvic ultrasound showing fibroids. While ultrasound can diagnose fibroids, it significantly underestimates the number of fibroids due to a much lower resolution than MRI. Occasionally patients with adenomyosis will be misdiagnosed on ultrasound as having fibroids (see Example 3).
The following 3 examples are pelvic MRI images from 3 different patients. They are all in the sagittal plane (side view).
Example 1: Normal uterus. No fibroids present. Note the normal uterine size. The white line is the uterine cavity. The thin dark lines on either side of the cavity is the transition between the uterine lining and muscular uterine wall (bright gray).
Example 2: Uterine fibroids. Note the enlarged uterus due to multiple fibroids (black circles).
Example 3: Diffuse adenomyosis. The uterus is enlarged up to the belly button (dark line at upper left corner of image). Note the thin dark lines present in Example 1 are not seen and replaced by very thick dark areas that surround the cavity (white line). Within these thick dark areas there are innumerable white dots which is characteristic of diffuse adenomyosis.
This patient had been told over many years (from multiple pelvic ultrasounds) that her uterine enlargement was due to fibroids and underscores the importance of obtaining MRI imaging.