The aim of our study was to develop a reliable technique for measuring volume of the fibroid uterus using Magnetic Resonance Imaging. We applied the Cavalieri method and standard calliper technique to measure the volume of the uterus and largest fibroid in 26 patients, and results were compared with “gold-standard” planimetry measurements. We found Cavalieri measurements to be unbiased, while calliper measurements systematically underestimated uterine volume (− 13.2%, P < 10−5) and had greater variance. Repeatability was similar for the 2 techniques (standard deviation [SD] = 4.0%-6.9%). Reproducibility of Cavalieri measurements was higher for measurement of uterine (SD = 9.0%) than fibroid volume (SD = 19.1%), whereas the reproducibility of calliper measurements was higher for fibroid (SD = 9.1%) than uterine volume (SD = 15.9%). The additional measurement time for the Cavalieri method was approximately 1 to 2 minutes. In conclusion, the Cavalieri method permits more accurate measurement of uterine and fibroid volumes and is suitable for application in both clinical practice and scientific research.
BairdDDDunsonDBHillMCCousinsDSchectmanJM. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol. 2003;188
(1):100–107.
CardozoERClarkADBanksNKHenneMBStegmannBJSegarsJH. The estimated annual cost of uterine leiomyomata in the United States. Am J Obstet Gynecol. 2012;206(3):211. e211–e219.
4.
van der KooijSMBipatSHehenkampWJAnkumWMReekersJA. Uterine artery embolization versus surgery in the treatment of symptomatic fibroids: a systematic review and metaanalysis. Am J Obstet Gynecol. 2011;205(4):317. e311–e318.
5.
FroelingVMeckelburgKSchreiterNF. Outcome of uterine artery embolization versus MR-guided high-intensity focused ultrasound treatment for uterine fibroids: long-term results. Eur J Radiol. 2013;82
(12):2265–2269.
6.
PeddadaSDLaughlinSKMinerK. Growth of uterine leiomyomata among premenopausal black and white women. Proc Natl Acad Sci U S A. 2008;105
(50):19887–19892.
7.
BroekmansFJHeitbrinkMAHompesPGSchouteEFalkeTSchoemakerJ. Quantitative MRI of uterine leiomyomas during triptorelin treatment: reproducibility of volume assessment and predictability of treatment response. Magn Reson Imaging. 1996;14
(10):1127–1135.
8.
SchlaffWDZerhouniEAHuthJAChenJDamewoodMDRockJA. A placebo-controlled trial of a depot gonadotropin-releasing hormone analogue (leuprolide) in the treatment of uterine leiomyomata. Obstet Gynecol. 1989;74
(6):856–862.
9.
BurnPRMcCallJMChinnRJVashishtASmithJRHealyJC. Uterine fibroleiomyoma: MR imaging appearances before and after embolization of uterine arteries. Radiology. 2000;214
(3):729–734.
10.
JhaRCAscherSMImaokaISpiesJB. Symptomatic fibroleiomyomata: MR imaging of the uterus before and after uterine arterial embolization. Radiology. 2000;217
(1):228–235.
11.
KatsumoriTKasaharaTKinYIchihashiS. Magnetic resonance angiography of uterine artery: changes with embolization using gelatin sponge particles alone for fibroids. Cardiovasc Intervent Radiol. 2007;30
(3):398–404.
12.
TakahashiKOkadaMImaokaISugimuraKMiyazakiK. Value of magnetic resonance imaging in predicting efficacy of GnRH analogue treatment for uterine leiomyoma. Hum Reprod. 2001;16
(9):1989–1994.
13.
ZawinMMcCarthySScouttLMComiteF. High-field MRI and US evaluation of the pelvis in women with leiomyomas. Magn Reson Imaging. 1990;8
(4):371–376.
14.
CowellPESlumingVAWilkinsonID. Effects of sex and age on regional prefrontal brain volume in two human cohorts. Eur J Neurosci. 2007;25
(1):307–318.
15.
SahinBEmirzeogluMUzunA. Unbiased estimation of the liver volume by the Cavalieri principle using magnetic resonance images. Eur J Radiol. 2003;47
(2):164–170.
16.
MazonakisMPagonidisKSchlosserT. Stereological estimation of left-ventricular volumetric and functional parameters from multidetector-row computed tomography data. Eur Radiol. 2008;18
(7):1338–1349.
17.
JoeBNSuhJHildeboltCFHovsepianDMJohnstonBBaeKT. MR volumetric measurements of the myomatous uterus: improved reliability of stereology over linear measurements. Acad Radiol. 2007;14
(4):455–462.
18.
MunroKIThrippletonMJWilliamsAR. Quantitative serial MRI of the treated fibroid uterus. PLoS ONE. 2014;9
(3):e89809.
19.
Cruz-OriveLM. Stereology of single objects. J Microsc. 1997;186
(2):93–107.
20.
RobertsNPuddephatMJMcNultyV. The benefit of stereology for quantitative radiology. Br J Radiol. 2000;73
(871):679–697.
21.
PuddephatMJ. Computer Interface for Convenient Application of Stereological Methods for Unbiased Estimation of Volume and Surface Area: Studies Using MRI With Particular Reference to the Human Brain[PhD thesis]. Liverpool: University of Liverpool; 1998.
22.
GundersenHJJensenEB. The efficiency of systematic sampling in stereology and its prediction. J Microsc. 1987;147
(pt 3):229–263.
KieuKSouchetSIstasJ. Precision of systematic sampling and transitive methods. J Stat Plan Infer. 1999;77:263–279.
25.
MatheronG.The Theory of Regionalized Variables and Its Application. Les Cahiers du Centre de Morphologie Mathematique de Fontainebleau ed: Centre de Morphologie Mathematique. Vol 5. Paris: Ecole National Superieure des Mines de Paris; 1971.
26.
VolkersNAHehenkampWJSpijkerboerAM. MR reproducibility in the assessment of uterine fibroids for patients scheduled for uterine artery embolization. Cardiovasc Intervent Radiol. 2008;31
(2):260–268.
27.
BlandJMAltmanDG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1
(8476):307–310.
