Diagnosis of Fibroid


Uterine fibroids, also termed leiomyomas or myomas, are growths of the uterus that are noncancerous and often appear during childbearing years. Most frequently these fibroids cause heavy menstrual bleeding and severe pelvic cramps, significantly compromising women’s quality of life. 

Accurate fibroid diagnosis is the key to effective treatment. Typical symptoms, physical examination and imaging helps physicians identify the presence of fibroids.  Dr. Sandeep employs a comprehensive approach to the diagnosis of fibroid, considering the medical history and a range of diagnostic tools.

Pelvic Exam:

A routine pelvic exam  allows doctor to feel for uterine abnormalities, helping identify fibroids’ presence and size. Large subserosal and intramural myomas often detected by pelvic examination with findings of uterine enlargement, irregularly shaped, firm, and nontender uterus.

Transvaginal sonography (TVS) Ultrasound:

  • Ultrasonography (USG) is the most readily available and least costly imaging technique to differentiate fibroids from other pelvic pathology. 
  • Ultrasound (US) is usually the first imaging study performed to confirm the presence of uterine fibroids. 
  • In sonography, fibroids are seen as focal masses with a heterogeneous nature. This varies from hypo- to hyper-echoic. Calcifications may be present at the rim.

Magnetic Resonance Imaging (MRI)

  • MRI is the modality of choice for imaging female pelvis due to its excellent soft tissue resolution and multiplanar cross-sectional imaging. 
  • This non-invasive test provides a more detailed view of the size and location of fibroids but also aids in identifying different types of tumors. 
  • MRI is superior to US for determining the location of fibroids within the uterus, especially pedunculated fibroids where the stalk may be difficult to measure or identify using trans- abdominal or transvaginal US
  • Fibroids have a classic imaging appearance. They are focal, rounded, or oval mass lesions with sharp, well-circumscribed margins and homogeneously decreased signal intensity (dark) on T2-weighted images, compared with that of the muscle layer, allowing it to distinguish it from normal uterus. 

  •  High signal rim on T2-weighted images corresponds to a pseudo-capsule of dilated lymphatics, veins, edema.

  • Fibroids with degeneration (hyaline, cystic, myxoid or red degeneration) may have higher signal intensity on T2-weighted MR. 

MRI allows detailed mapping of fibroid mapping.  Fibroid mapping means understanding its exact origin of fibroid, its location in uterus, number and size and in differential diagnostic issues. 

1)     Location of Fibroid:

  • MRI identifies the exact location of fibroid with respect to layers of uterus (endometrium, myometrium and serosa), within a specific region of the uterus (fundus, body, lower uterine body) and in lateral and antero-posterior location. 

  • Degree of intramural or endometrial involvement.

  • MRI demonstrates proximity of fibroid to the urinary bladder and rectum.

  • Accurate identification of fibroid location allows clinicians to select the best treatment plan for the patient, be it hysteroscopy, laparoscopy/laparotomy, or Uterine fibroid embolization (UFE). 

2)    Uterine size and number of fibroids:

  • MRI estimates the size and number of fibroids accurately.

  • An estimation of the number of fibroids will determine if fibroid resection is feasible by myomectomy and would be reasonable for symptom control. 

3.     Contrast enhancement: 

  • Intensity of contrast enhancement indicates vascularity of fibroid.

  • Moderate enhancement of fibroids predicts good response to UFE treatment. 

  • Non-enhancing areas suggest necrosis and red-degeneration.

4: Differentiating other Uterine lesions: 

  • MRI helps differentiate fibroid from other lesions like adenomyosis and  malignancy such as leiomyosarcoma. 

Fused MR and bilateral uterine artery angiography image showed highly vascular fibroids.

Submucosal fibroid (asterisk) protruding inside the uterine cavity.

Multiple sub-serosal fibroids (asterisk) bulging outside the uterine contour.

MRI T2 (A, B) and post contrast (C, D) images showed multiple enhancing sub-serosal fibroids bulging outside the uterine contour.

Uterine Fibroids Diagnosis: A Comprehensive Exploration

At Dr. Sandeep’s Fibroid Clinic, we prioritize your reproductive health by employing state-of-the-art diagnostic tools. Diagnosis of fibroid involves a meticulous examination, and Dr. Sandeep ensures a comprehensive imaging diagnosis.

Consult with Dr. Sandeep