Dayananda Kumar R1, Anjani M. Reddy2, Raja Parthiban3, N. Kudva4, Anilesh P. Singh5, Chiranth N6, Anshita Agrawal7

Leiomyomas are the most common benign uterine tumours. They are usually asymptomatic but may cause menometrorrhagia, abdominal pain and infertility. They may be single or multiple and may have variable size. When fibroids increase in size, their vascular supply becomes insufficient causing hyaline, myxoid, cystic and haemorrhagic degeneration. Differential diagnoses include adenomyosis, solid adnexal masses, and focal contraction of myometrium and leiomyosarcomas of the uterus. Our purpose was to describe USG, MR imaging findings, histological features and clinical aspects of uterine fibroids.
This prospective study was conducted in the Department of Radiodiagnosis and Department of Pathology, MVJ Medical College and Research Hospital from January 2014 to December 2015. Our MR protocol includes sagittal, coronal, axial T2-weighted fast spin-echo, T1-weighted axial spin echo and axial short tau inversion recovery sequence. Optional sequences include sagittal and coronal short tau inversion recovery, axial diffusion weighted sequence, axial GRE sequence and sagittal T2 weighted 3D space sequence.
Uterine leiomyomas typically appear as well-defined, homogeneously hypointense masses on T2-weighted images and with intermediate signal intensity on T1-weighted images. Hypercellular leiomyomas show higher signal intensity than that of non-degenerated leiomyomas on T2 weighted images. Degenerated leiomyomas show signal intensity on T2-weighted images and on T1-weighted images obtained before and after contrast administration. 75 cases of leiomyomas were detected. In our study, majority of the cases belonged to the 41-50 years age group. Intramural fibroids were seen in 45 cases, subserosal fibroids were seen in 23 and submucosal fibroids in 15 cases. Both intramural and subserosal fibroids were seen in 7 cases. Broad ligament fibroids were seen in two cases. Pathological features of hyaline degeneration were noted in 5 cases, cystic degeneration in 7 cases, and red degeneration in one case.
MRI is the most specific imaging modality in detection and localisation of uterine leiomyomas. Leiomyomas characterisation, often possible with MR imaging, requires knowledge of pathological features and imaging findings associated with the different kinds of degeneration. MRI is useful in planning the correct therapeutic strategy and in followup after therapy.