Three-dimensional power Doppler in the evaluation of painful leiomyomas and focal uterine thickening in pregnancy.
OBJECTIVE
To determine the usefulness of 3-dimensional (3D) power Doppler ultrasound in distinguishing painful leiomyomas from focal myometrial contractions or nonpainful leiomyomas in pregnancy.


METHODS
A 2D section of the area of interest in the uterine wall was first obtained in 29 patients to determine whether the pain originated from a myoma or a uterine contraction. Then, volume acquisition was activated and Doppler indices (vascularization index, flow index, and vascularization-flow index) were calculated for thickened and normal uterine wall.


RESULTS
Of 15 patients found to have uterine myomas, 11 had multiple tumors and 4 had single tumors. In the remaining 14 patients the painful uterine thickening proved to be a focal contraction. Painful segments of uterine thickening were associated with lower Doppler indices. Painful myomas were found to have significantly lower indices than normal uterine wall (P=0.008, 0.03, and 0.01 for VI, FI, and VFI, respectively, vs. 0.001, 0.003, and 0.01). However, the differences in indices between nonpainful myomas and uterine wall on the one hand, and nonpainful myomas and focal uterine contractions on the other, were not statistically significant.


CONCLUSIONS
Three-dimensional power Doppler ultrasound may be a sensitive and reliable tool for distinguishing painful uterine myomas from focal myometrial contractions and nonpainful myomas.
Degani
S
S
Ultrasound Unit, Department of Obstetrics and Gynecology, Bnai-Zion Medical Center, Ruth and Baruch Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel. sdegani@tx.technion.ac.il
Tamir
A
A
Leibovitz
Z
Z
Shapiro
I
I
Gonen
R
R
Ohel
G
G
D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D007889:Leiomyoma / Q000000981:diagnostic imaging*; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000000981:diagnostic imaging*; D018608:Ultrasonography, Doppler; D014590:Uterine Contraction; D014594:Uterine Neoplasms / Q000000981:diagnostic imaging*; D014599:Uterus / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000473:pathology