Role of MRI in the evaluation of diffusely enlarged uterus

Background: Diffuse uterine enlargement is a common clinical finding. Because this abnormality can represent a physiological manifestation, benign tumor, or malignancy, the diagnostic dilemma of a diffusely enlarged uterus can be challenging. Clinical findings can provide valuable information in regard to physiologic effects, pregnancy-related changes, and hormonal causes.Objective: The ability of MRI to differentiate between pathological entities that cause uterine enlargement.Methods: During the period of June 2008 to July 2009, 20 female patient were evaluated by history taking, clinical examination, ultrasound and Magnetic resonance . Then pathological examination after open surgery and D&C.Results: Four cases was diagnosed as endometrial carcinoma by pathological examination after D & C. MRI was able to detect the four cases and to define the stage of carcinoma wile ultrasound diagnose two cases and miss two as endometrial hyperplesia. Adenomyosis was diagnosed in two cases by pathological examination after labartomy. MRI was able to diagnose both cases while the ultrasound diagnosed one and missed the other as leiomyoma. Benign leiomyoma was diagnosed in 6 cases by pathological examination after surgery. Leimyoma was diagnosed by MRI in eight patients but two cases did not do the surgical removal of the lesion . MRI diagnose two of these cases as multiple diffuse leiomyoma. Ultrasound was diagnose nine case as leiomyoma , one of those cases was proved to be adenomyosis. Chronic cervicites was diagnosed by pathological examination after D&C in two cases .MRI diagnosed both cases while the ultrasound miss both cases as endometrial hyperplesia. Endometrial polyp was diagnosed by pathology in two cases. MRI was able to detect both cases while Ultrasound diagnosed one and missed one as endometrial hyperplesia.Conclusion: Diffuse uterine enlargement encompasses various conditions from physiologic changes to benign or malignant disease. Every effort must be done to diagnose the cause and exclude the life threatening cause. Radiological examination is a cornerstone in the diagnostic work up. History and clinical examination are very important before radiological examination. US allows easy, noninvasive, cost-effective detection or confirmation of uterine enlargement. US was unable to detect actual size and extension of lesions and tumors. MR imaging can provide valuable information regarding good differentiation between layers of uterus for good anatomical localization of the lesions. MRI also can detect the actual size of the lesion with three dimensional diameters .MRI can provide the extention of the lesion and invasion of the myometrium. MRI can be use as diagnostic tool in staging of neoplasm as preoperative evaluation. US thus represents a primary diagnostic tool, whereas MR imaging assumes the role of a problem-solving tool.