The reason for writing this article, as long as the previous consultation in a patient, suggested that she do a MRI examination, so that it is more convenient for us to carry out the assessment, in my opinion this is a very routine suggestion, the other party replied: uterine fibroids are required to do an MRI, you guys are over-medical it. Then he hung up the phone, and the consultation was closed. Indeed, in the past, when we checked fibroids, we did ultrasound, which is cheap and relatively easy to do, and we don’t have to worry about radiation (in fact, magnetic resonance is also radiation-free). Of course, ultrasound is still recommended for patients with asymptomatic fibroids, but for patients with symptomatic fibroids, or those who have fertility requirements and need to be evaluated to see if the fibroids are affecting them, we would recommend an MRI. What is the rationale for this? Let’s take a look at what is currently happening with ultrasound in this country. The most common report is this one, which consists of a description of the ultrasound examination + conclusion + illustrations, which will include images of the fibroids found during the examination. Of course, in some regions, the ultrasound report does not have illustrations, but only a description of the ultrasound examination and a conclusion. The reason for omitting the images, besides the fact that the price of the test may not cover the cost of printing, is that ultrasound doctors may feel that the clinician is only looking at a conclusion. In fact, ultrasound is indeed a very suitable means of examination for obstetrics and gynecology, through the transvaginal ultrasound, can clearly visualize the situation of the uterus and adnexa, but the ultrasound examination is a dynamic process, just rely on the written record, even with the accompanying pictures, can not be a complete restoration of the amount of information obtained during the examination. As a simple example, uterine fibroids are generally described as submucosal, intermural, and subplasma in the ultrasound report, but in the actual clinical application, we are currently more inclined to use FIGO’s classification, which categorizes uterine fibroids into types 0-8 (as shown below, type 8 is a special location of fibroids, which is not drawn in the figure). FIGO uterine fibroid typing schematic diagram We can see that type 3-5 fibroids may be described as intermural fibroids under ultrasonography, and in some cases, because of the clarity of ultrasonography equipment, experience of the examining doctor, and the situation of the day, type 2 fibroids may be mistaken as intermural fibroids (we have even encountered that ultrasonography reports of the top hospitals in China were written as intermural fibroids, but in reality, hysteroscopy found intermural fibroids, which are not the most common type of fibroids in the world). Although all of these types are “intermural fibroids”, there is a big difference in whether they cause symptoms, have an impact on subsequent fertility, and require follow-up treatment. Types 4 and 5 fibroids generally do not cause symptoms and are unlikely to affect fertility, whereas type 2 fibroids mostly cause symptoms and are unlikely to affect fertility. Type 2, on the other hand, will mostly cause symptoms and may affect fertility, while type 3 depends on the specific situation. Therefore, when dealing with patients with symptomatic fibroids, if we choose to do ultrasound evaluation, we prefer to see the ultrasound in person, so that we can easily get the complete information we need, which in turn will help us to make subsequent judgment and provide treatment plan. In fact, in foreign countries, the ultrasound is also usually performed by the obstetrician/gynecologist himself/herself. Domestically, it is done by the ultrasound department, and obstetricians and gynecologists do not have the time and energy to be able to go to the site to see the ultrasound (usually the department is not set up on the same floor, and both departments are overcrowded), and although the diagnostic level of our domestic ultrasonographers is very good, they rely only on the textual descriptions, and because the ultrasound is a heavier task, the report is usually more templated, and it is difficult to get the information we need in a clear manner. information we need. At this time we can only rely on MRI (Magnetic Resonance Imaging) to help, and ultrasound we can only see the doctor’s text description and a limited number of pictures, but MRI we get the whole pelvis digital data, can be from a different angle, a complete understanding of the whole uterus and the situation of the uterine fibroids. This gives us a clear picture of where each fibroid is located, which fibroid is causing the clinical symptoms, and whether this fibroid will have an impact on fertility if it continues to grow, among other things. MRI images can not only be visualized from a two-dimensional plane, but can also be combined with other angles to clearly locate the same fibroid. In addition to providing the location of the fibroid, MRI can also provide us with a lot of other information. Usually, a direction of the T2-weighted sequences will provide us with about 26 or even more images, which is enough to completely show the different levels of the uterus, as well as the relationship with the surrounding intestines, bowel, and other organs, and the surrounding fibroid. It is enough to show the different layers of the uterus, the relationship with the surrounding tissues such as the bowel and bladder, etc. And through the difference in signal between the fibroid and the myometrium under T2-weighting, we can initially determine whether the fibroid is suitable for the magnetic wave therapy that we are currently carrying out, if it is a high signal (which indicates that the tissue itself is rich in water content or blood supply), the effect of the magnetic wave therapy may not be too high, and naturally, other modalities will be more suitable. As for the blood supply of fibroids, MRI can also enhance the image by injecting enhancers, so as to know whether there is still blood supply in the fibroids, and fibroids without blood supply can be spontaneously necrotic and atrophic even if they are not treated, and if there is a blood supply, whether it is abundant or general, it will be helpful for the selection of the subsequent treatment modality. The left figure shows a T2 low-signal leiomyoma, which is suitable for magnetic wave therapy, and the right figure shows a T2 high-signal leiomyoma, which may not be effective if magnetic wave therapy is done. The image on the right is a T2-weighted plain scan with 3 red circles for each of the 3 fibroids. The image on the left is an image of the same level after enhancement, where one of the fibroids has a lower blood supply than the myometrium, and the other 2 fibroids have a comparable blood supply to the myometrium. The question of benign and malignant is also of concern to many, and MRI can also assist in determining whether a lesion is a conscientious fibroid, or whether it may be a malignant uterine sarcoma. Especially in cases where the fibroid itself has degeneration, it is difficult to distinguish its nature through ultrasound, and with the help of magnetic resonance, some evidence can be provided side by side. MRI image of enhanced delayed visualization of benign uterine fibroids MRI image of enhanced delayed visualization of uterine sarcoma Regarding the treatment of uterine fibroids, we currently have the magnetic wave treatment that does not require incision, minimally invasive laparoscopy, hysteroscopy, Novasure treatment to control heavy menstruation, and so on, so many surgical procedures, all of them have their own applicability, so we can only make more reasonable decisions if we have a clear understanding of the specific conditions of the patient before the operation. Therefore, with a clear understanding of the patient’s specific situation before surgery, we can choose the treatment more reasonably, so as to provide patients with individualized treatment plans, which is probably also regarded as the “precision treatment” for uterine fibroids. So, if we only consider laparoscopy as a modality, is it that magnetic resonance is not necessary? Of course not. Knowing the location of the fibroids and their relationship with the lining of the uterus, we can better design the incision on the uterus, so that we can use the most appropriate incision to remove the fibroids. Regarding the help of magnetic resonance in the surgery, there are overseas teams that have already used magnetic resonance to perform 3D reconstruction and then formulate the surgical plan, and although we have not yet used such intuitive technology, the concepts and the result is basically the same. The concept as well as the results are basically the same. Are there any disadvantages of MRI? First of all, it is not as convenient as an ultrasound, which usually requires an appointment and a wait of a few days to half a month. It’s also more expensive than an ultrasound, but it’s still within the acceptable range, and we think it’s worthwhile for those who have symptoms and are ready to choose a treatment option, or to assess the impact of fibroids on fertility before getting pregnant. Of course, for clinical follow-up of asymptomatic fibroids, ultrasound is perfectly adequate, and there is no need to go for MRI just because we say how good it is, which is not a good idea to cause unnecessary waste of medical resources.