Obstet Gynecol Sci.  2018 May;61(3):395-403. 10.5468/ogs.2018.61.3.395.

Doppler sonography of perifibroid and intrafibroid arteries of uterine leiomyomas

• Idowu BM
• Ibitoye BO

• KMID: 2416129
• DOI: http://doi.org/10.5468/ogs.2018.61.3.395

Abstract

OBJECTIVE
To sonographically evaluate the dominant fibroid nodule vascularity and flow velocity pattern of perifibroid and intrafibroid arteries.
METHODS
We recruited 140 women with uterine fibroids. Their uteri were scanned to determine the vascularity of fibroid nodules and the Doppler indices of the fibroid arteries.
RESULTS
The median volume of the dominant leiomyoma nodule was 133 cm3 (range=1.5-2,575 cm3). Eighty-three subjects (59.3%) had a dominant leiomyoma nodule volume of ≤200.0 cm3 while the volume of the dominant leiomyoma nodule was >200.0 cm3 in 57 (40.7%) subjects. The dominant fibroid nodule was vascular in 137 (97.9%) subjects and avascular in 3 (2.1%). All the perifibroid artery indices (except the end-diastolic velocity [EDV] and diastolic average ratio [DAR]) are significantly higher than those of the intrafibroid artery. The mean Doppler indices of perifibroid vs. intrafibroid arteries as follows: peak systolic velocity (PSV; 52.1 vs. 45.4 cm/s); EDV (21.1 vs. 22.4 cm/s); time-averaged maximum velocity (TAMX; 31.5 vs. 30.4 cm/s); time- averaged mean velocity (Tmean; 14.3 vs. 13.8 cm/s); pulsatility index (PI; 1.1 vs. 0.8); resistive index (RI; 0.6 vs. 0.5); systolic-diastolic ratio (SDR; 2.7 vs. 2.1); impedance index (ImI; 2.7 vs. 2.1); and DAR (0.66 vs. 0.74); P < 0.001 for all indices.
CONCLUSION
The predominant pattern of fibroid vascularity is peripheral vascularity and the perifibroid artery indices (except EDV and DAR) are significantly higher than those of the intrafibroid artery. Recurrent fibroids in women with previous myomectomy had significantly higher intrafibroid PI, RI, SDR, and ImI than those without previous myomectomy.

Keyword

Doppler ultrasonography; Leiomyoma; Myomectomy; Fibroid uterus; Uterine artery

MeSH Terms

Arteries*
Electric Impedance
Female
Humans
Leiomyoma*
Ultrasonography, Doppler
Uterine Artery
Uterus

Figure

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  Fig. 1 Longitudinal triplex sonogram of a myomatous uterus showing the waveform pattern and Doppler indices of a perifibroid (peripheral) artery.

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  Fig. 2 Longitudinal triplex sonogram of a myomatous uterus showing the waveform pattern and Doppler indices of an intrafibroid (core) artery.

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