Uterine Artery Doppler Velocimetry of Uterine Leiomyomas in Nigerian Women

Abstract

Objective To describe the blood flow velocities and impedance indices changes in the uterine arteries of leiomyomatous uteri using Doppler sonography. Methods This was a prospective, case-control study conducted on 140 premenopausal women with sonographic diagnosis of uterine leiomyoma and 140 premenopausal controls without leiomyomas. Pelvic sonography was performed to diagnose and characterize the leiomyomas. The hemodynamics of the ascending branches of both main uterine arteries was assessed by Doppler interrogation. Statistical analysis was performed mainly using non-parametric tests. Results The median uterine volume of the subjects was 556 cm 3 , while that of the controls was 90.5 cm 3 (p < 0.001). The mean peak systolic velocity (PSV), end-diastolic velocity (EDV), time-averaged maximum velocity (TAMX), time-averaged mean velocity (Tmean), acceleration time (AT), acceleration index (AI), diastolic/systolic ratio (DSR), diastolic average ratio (DAR), and inverse pulsatility index (PI) were significantly higher in the subjects (94.2 cm/s, 29.7 cm/s, 49.1 cm/s, 25.5 cm/s, 118 ms, 0.8, 0.3, 0.6, and 0.8 respectively) compared with the controls (54.2 cm/s, 7.7 cm/s, 20.0 cm/s, 10.0 cm/s, 92.0 ms, 0.6, 0.1, 0.4, and 0.4 respectively); p < 0.001 for all values. Conversely, the mean PI, resistivity index (RI), systolic/diastolic ratio (SDR) and impedance index (ImI) of the subjects (1.52, 0.70, 3.81, and 3.81 respectively) were significantly lower than those of the controls (2.38, 0.86, 7.23, and 7.24 respectively); p < 0.001 for all values. Conclusion There is a significantly increased perfusion of leiomyomatous uteri that is most likely due to uterine enlargement. ResumoObjetivo Descrever as velocidades do fluxo sanguíneo e as alterações dos índices de impedância nas artérias uterinas leiomiomatoso utilizando a ultrassonografia Doppler. Métodos Estudo prospectivo, caso-controle, realizado em 140 mulheres pré-menopáusicas com diagnóstico ultrassonográfico de leiomioma uterino e em 140 controles na pré-menopausa sem leiomiomas. A ultrassonografia pélvica foi realizada para

Doppler sonography of perifibroid and intrafibroid arteries of uterine leiomyomas

“…Furthermore, the perifibroid and intrafibroid Doppler indices did not differ significantly with presence or absence of symptomatology generally and menorrhagia specifically. This is in contrast to previous report [ 26 ] of significantly higher PSV, EDV, TAMX in the main uterine artery of symptomatic subjects as well as higher main uterine artery flow velocities and lower resistance to flow in those with menorrhagia. Furthermore, Sladkevicius et al [ 31 ] reported “much higher TAMX values from the arteries supplying the large myomas of the symptomatic premenopausal women than from those supplying the small myomas of the asymptomatic postmenopausal women.” However, we are of the opinion that the documented elevated TAMX by Sladkevicius and co-workers [ 31 ] is more likely due to the difference in the myoma sizes of the 2 groups.…”

“…In addition, a possible contribution to this Doppler picture from healing by fibrosis, if any, is uncertain but plausible. These intrafibroid artery Doppler differences between post-myomectomy subjects and those without previous myomectomy were not observed in the main uterine artery as we reported previously [ 26 ] or in the perifibroid artery of this study.…”

Fi̇broi̇dleri̇n Doppler Ultrasonografi̇ Ve Manyeti̇k Rezonans Görüntülemesi̇ni̇n Karşilaştirilmasi

“…Measurement of fibroid growth rates has an important role in the development of tumor-inhibiting treatment modalities for perimenopausal women. Unlike Doppler USG, MRI remains as an expensive imaging tool that requires more resources (15). Previously, findings from some other studies have confirmed the general evidence for the reliability of Doppler USG when performed by experienced and skilled sonographers (16 -22).…”

Uterine fibroid vascularization: from morphological evidence to clinical implications

“…With their descending cervical and ascending uterine branches, the arcuate arteries can be visualized in the outer myometrium, often close to the uterine border. Doppler waveforms of uterine artery typically present a high-velocity, high-resistance pattern, and an identifiable dicrotic notch (Bhatt et al, 2006;Idowu et al, 2017;Secil et al, 2008).…”