Contrast-enhanced Ultrasonography vs Magnetic Resonance Imaging in the Evaluation of Uterine Lesions: A Prospective Observational Study

Abstract

Aim: To study and compare the number, size, location, and character of uterine lesions identified by contrast-enhanced ultrasonography (CEUS) and magnetic resonance imaging (MRI) and correlate the results with gross intraoperative and histopathological findings. Background: Contrast-enhanced ultrasonography is a newly emerging diagnostic modality that has revolutionized ultrasound imaging. The technique involves the administration of intravenous contrast agents consisting of microbubbles of gas to the systemic circulation. The distinguished acoustic properties of the microbubbles enable them to produce high-frequency harmonics that are used to enhance the ultrasound images. Contrast-enhanced US provides the ability to detect intralesional microvascularity; therefore, it could be an effective alternative to computed tomography and MRI. It can produce real-time imaging, unlike MRI, which extends its applicability to the assessment of interventional procedures. The contrast agent used in our study is known as SonoVue, which is a second-generation contrast agent made of sulfur hexafluoride microbubbles. Methods: It was a prospective observational study carried out over a period of one year with a sample size of 32 study subjects. Women over 18 years of age who were undergoing evaluation for suspected uterine lesions were included in the study. Results: Fibroids – 21 cases of fibroids were studied. There was no significant difference between CEUS and MRI reports with respect to the size of the lesions as shown by a t-test (t = 0.13, p = 0.89) and Pearson correlation coefficient (r = 0.96, p = 0.001). Disagreement regarding location was seen only in a few number of cases. Gross perioperative findings and histopathology reports showed 100% concordance with the investigative results. Adenomyomas – 11 cases of focal adenomyomas and diffuse adenomyosis with focal lesions were studied. Among the 10 focal lesions reported, a t-test showed no significant difference (t = 0.05, p = 0.95) in sizes between CEUS and MRI reports, and a Pearson correlation coefficient suggested a high positive correlation (r = 0.92, p = 0.001). There was 100% concordance between CEUS and MRI findings regarding the character and location of the lesion, and histopathological results showed a discrepancy only in a single case. Conclusion: A total of 32 subjects with uterine lesions were evaluated. Contrast-enhanced ultrasonography and MRI findings were compared with regard to size, character, location, intraoperative appearance, and histopathological results. No statistically significant difference was found. This brings us to the conclusion that CEUS can be considered an effective alternative to MRI for the evaluation of uterine lesions. Clinical significance: An ultrasonography is the first sought investigation in any suspected uterine lesion. Therefore, the application of a contrast agent in the same setting makes the diagnosis all the more informative and effective. Contrast-enhanced ultrasonography has several advantages over CT and MRI. Since its first application in the late 1960s, US contrast agents have grown tremendously. Contrast-enhanced ultrasonography has the ability to add substantial value in imaging gynecological disease, and indications for its use in the female pelvis are expected to continue evolving. © The Author(s). 2025.