EP20.09: Elastographic and vascular characteristics of uterine fibroids

To assess the tissue stiffness of uterine fibroids (UF) and their vascularisation using transvaginal ultrasound (US). Images from 21 patients were obtained by a single radiologist with 30 years of experience. The tissue stiffness of UF was measured using shear wave elastography (SWE) and strain elastography (STE), and vascularisation was observed using superb microvascular imaging (SMI). The examinations were performed using the Aplio i 800 (Canon) and Epiq 5G (Philips). The hardness of fibroids was assessed using either SWE or Strain elastography, and the data obtained in this process allowed the selection of the best strategy for approaching the fibroids during radiofrequency ablation (RFA). The study of vascularisation through SMI played an important role, as the most vascularised areas are the most relevant target in RFA. The tissue stiffness of fibroids and their vascularisation were successfully evaluated using the chosen method, revealing that the difference in fibroid stiffness is associated with differences in echogenicity. More hypoechoic fibroids tend to be softer. It was observed that there was a predominance of UF in the 2-5 classification (n = 9 - 42.9%). Furthermore, there was a predominance of hypoechoic lesions (n = 19 - 90.5%). Vascularisation in most cases was considered moderate in 9 cases (42,9%). Most UF were considered to have intermediate stiffness (n = 10 - 47.6%). The use of SWE or Strain elastography and the study of vascularisation through SMI enable the establishment of the specific physical characteristics of UF, facilitating the planning of the therapeutic approach. The use of SWE or STE elastography and SMI made it possible to establish the stiffness and vascularisation of UF, and possible correlation with the FIGO classification. Additional studies will be necessary to determine whether fibroid stiffness analysed by SWE or STE will serve as a parameter for determining the optimal treatment and subsequently assessing therapeutic response.