The Clinical Impact of Gynecologic MRI

Abstract

OBJECTIVE. This study assessed the clinical impact of pelvic MRI performed after the diagnosis of an indeterminate pelvic mass on ultrasound or CT. MATERIALS AND METHODS. The radiologic records of 567 patients who underwent pelvic MRI at our hospital from 2004 to 2006 were reviewed. Of these patients, 214 patients underwent pelvic MRI for evaluation of a gynecologic mass detected on a preceding ultrasound or CT examination; this group of patients constituted the basis of our study. The imaging and clinical records from the database were used for our analysis. The medical records were reviewed for the impact of the radiologic findings on patient treatment, and the results were tabulated for the findings of the first modality, whether the first modality provided a diagnosis, what management plan would be made according to the first modality, and what management plan would be made as a result of the MRI. The adequacy of the imaging study was assessed on the basis of either obtaining an accurate exact diagnosis or ascertaining at the minimum whether the mass was benign or malignant. Further endpoints included specificity and sensitivity of the individual modalities in the diagnosis of a specific gynecologic mass and whether clinical management was altered. Exact binomial CIs were computed for individual proportions. RESULTS. The clinical management of the patient was altered as a result of MRI in 77% of the cases (CI = 0.70-0.82). Surgery was avoided in 36% (CI = 0.29-0.43), and surgery was changed to a more appropriate method (laparoscopy vs laparotomy, involvement or not of a gynecologic oncologist) in an additional 17% (CI = 0.12-0.23). CONCLUSION. Without having undergone MRI, many of the women and girls in this study would have undergone unnecessary surgery; a more costly type of surgery; or long-term follow-up with the associated financial costs, personal and physical costs, and mental costs from the resultant anxiety of an unresolved indeterminate mass.

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“…The standardization of preoperative imaging evaluation of adnexal masses is highly desirable, as misinterpretation of results and reporting bias can lead to severe consequences for patients, most notably, unnecessary surgery and/or delayed onset of the treatment of potentially lethal disease (20). Several attempts to address failures in imaging methods are currently underway; they range from the modelling of US evaluation and reporting, such as the simple rules of the International Ovarian Tumor Analysis group (6, 7), to the proposition ADNEX MR scoring system based on a simplified MRI protocol • 67 Uterine cancer 1 (13) Other (lymphoma) 1 (1.3)…”

Avaliação do desempenho de um sistema de escore de imagem por ressonância magnética para massas anexiais

“…Essas mudanças tem um impacto importante e direto no bem estar físico e emocional dessas mulheres (32). Salienta-se que a RM é o melhor método de imagem no planejamento préoperatório de mulheres com contraindicação ao uso do contraste iodado para TC, gestantes, adolescentes e mulheres jovens (9).…”