Illuminating the Intricacies: A Comparative Cross-Sectional Sonographic Evaluation of Degenerative Changes in Leiomyomas Through Post-Processing Technique

<b>Background</b>: Leiomyomas are benign tumors that may cause symptoms and affect fertility, requiring careful assessment. Magnetic Resonance Imaging (MRI) becomes crucial when ultrasonography results are inconclusive; however, it is expensive and time-consuming. Utilizing post-processing techniques could enhance the ultrasound results. Using ultrasound with Fiji (ImageJ) enables precise evaluation of leiomyoma degeneration and may reduce the need for MRI. Aim: This study aims to evaluate the effectiveness of a post-processing technique using Fiji (ImageJ) to detect degenerative changes in leiomyomas and compare these findings with those obtained from conventional ultrasound and MRI results. <b>Methods</b>: A cross-sectional analytical study was conducted at King Saud Medical City involving 41 females diagnosed with uterine leiomyomas using ultrasound and MRI. Ultrasound images were analyzed using Fiji software to identify degenerative changes and compare results with ultrasound and MRI reports. <b>Results</b>: ImageJ outperformed ultrasound across all diagnostic metrics, with higher sensitivity (84.2% vs. 63.2%), specificity (81.8% vs. 22.7%), and accuracy (82.9% vs. 41.5%). ROC analysis showed superior diagnostic performance of ImageJ (AUC = 0.830) compared to ultrasound (AUC = 0.429), with a significant correlation to MRI findings (<i>p</i> < 0.001). Fibroids with and without degeneration showed no significant differences in Fiji parameters (<i>p</i> > 0.05). <b>Conclusions</b>: Integrating post-processing tools such as ImageJ with ultrasound imaging significantly improves the detection of degenerative changes in uterine leiomyomas, potentially reducing dependence on costly and less accessible modalities like MRI. Future studies should utilize a prospective design with larger sample sizes to strengthen the validity and generalizability of these findings.