Role of TVS and MRI imaging in perimenopausal bleeding

Abstract

Abnormal uterine bleeding is any variation in the normal menstrual cycle, Includes: changes in frequency, duration and amount of blood loss during or in between the cycles. Approximately 70% of all gynecological consultations in perimenopausal and postmenopausal women are for abnormal uterine bleeding. There complaints may significantly affect the quality of life and lead to surgical intervention. TVS is an inexpensive, non-invasive, easly available and a convenient method to assess the uterine pathology. It is recommended as the 1st line diagnostic tool for assessing uterine pathology in perimenopausal age women presenting with abnormal uterine bleeding.To differentiate and characterize uterine and ovarian lesions based on MRI and TVS findings. To identify organ of origin of uterine and ovarian lesions based on MRI and TVS findings. To diagnose pathologies which have a difficulty in detection with TVS.40 patients in perimenopausal age group with complain of abnormal uterine bleeding were subjected to TVS and MRI examination. Final correlation with histopathology was done wherever it was acquired.Among 40 females, majority of them were in pre menopause period 25 (62.5%) and the rest in the post menopause period 15(37.5%). Among 40, majority were diagnose fibroids 14(37.5%), adnexal lesions 11(27.5%), carcinoma of cervix 5(12.5%), endometrial lesions 6(12.5%)and adenomyosis 4(10.0%). Adnexal lesions start in early age itself (35±2). Endometrial lesions(51±8) and carcinoma of cervix(55±6) were reported mostly in the post menopausal periods. Fibroids (40±5)and Adenomyosis(42±4) were reported in middle age. Among 11 patients TVS diagnosed 4 as Complex Adnexal Cysts, 3 as Dermoid, 2 as Simple ovarian Cyst, 1 as haemorrhagic Cyst and 1 as Possibly hydrosalphinx and MRI diagnosed 3 as Complex Adnexal Cysts, 3 as Dermoid, 2 as Simple ovarian cysts, 2 as haemorrhagic cyst and 1 as Hydrosalphinx. MRI is found to be more accurate and precise in comparison to ultrasound to characterize, localize and evaluate the number of lesions both benign and malignant along with its staging in pelvic pathologies. While TVS lacks specificity and sensitivity in relation to MRI but acts as a great screening tool in evaluation and further management. MRI is accordingly a more precise preoperative imaging modality for portraying and distinguishing the distinct features of varied lesions.