Magnetic Resonance Imaging–Based Three Dimensional Patient-Specific Reconstruction of Uterine Fibromatosis: Impact on Surgery

Objective: A magnetic resonance imaging (MRI)–based three-dimensional (3D) reconstruction of uteri anatomy was applied to determine if this reconstruction had diagnostic accuracy and an effect on planning and performance of surgical procedures for uterine fibromatosis. Materials and Methods: Patient-specific 3D models of the uteri of 18 women with symptomatic fibromatosis selected for surgery were obtained from MRI images with semiautomated segmentation routines and were shown to a surgeon at the time of presurgical planning and during surgery. Diagnostic accuracy of the 3D reconstruction versus transvaginal ultrasound (TVUS) in identifying and locating the myomas was tested. The impact of the 3D modeling on the choice and the performance of surgery was compared with 30 comparable procedures for which MRI was not available. Results: Sensitivity of the 3D imaging system was higher than TVUS, at 97% versus 72%. Preoperative visualization of the 3D images induced the surgeon to shift from a presurgical plan of open surgery to a mini-invasive technique in 22% of patients and from total hysterectomy to myomectomy in 31% of patients. Conclusions: 3D imaging of uteri with a MRI-based system identifies and locates myomas with high sensitivity and appears to be useful for both planning and execution of surgery.