Elastography of uterine myomas and correlation to intra- and postoperative parameters

Purpose: This prospective study evaluated the sonoelastographic characteristics of uterine myomas and the correlation to intra- and postoperative parameters.

Material & methods: A collective of 112 patients with 189 uterine myomas were examined pre-operatively by transvaginal sonography and additional elastography. The size of the myomas was measured in the conventional B-mode image, followed by sonoelastographic evaluation of strain values in the myomas and in the myometrium. 78 patients had a hysterectomy, 49 patients an enucleation of the myomas. The preoperative imaging results were correlated to postoperative myoma weight, volume, density and velocity of morcellation (g/min) of the myomas.

Results: Sonoelastography was able to clearly identify myomas from normal surrounding uterine tissue regularly having a higher stiffness represented in blue. Strain values differed highly significant between myoma and surrounding myometrium. Strain values of the myoma were associated with BMI (p < 0.001), velocity of morcellation (0.014) and a trend to association to density of the myoma (p = 0.052) was found. Strain values in the myometrium were significantly higher (softer myometrium) in cases of higher myoma volume (p = 0.021).

Conclusion: Sonoelastography is able to identify myomas from normal surrounding uterine tissue by their regularly higher stiffness. The lower the strain values in the myomas the higher their density and the lower the velocity of morcellation. The preoperative measurement of the myomas using elastography can help to optimize planning of surgery.