Dynamic contrast-enhanced MR imaging to assess physiologic variations of myometrial perfusion

To prospectively evaluate the ability of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to assess physiological microvascular states in normal myometrium. Eighty-five women (62 women of reproductive age, 23 postmenopausal) undergoing DCE-MRI of the pelvis were included. Microvascular parameters for the inner and outer myometrium were analysed using a pharmacokinetic model. These parameters were tissue blood flow (F), blood volume fraction (V (b)), permeability-surface area product (PS), interstitial volume fraction (V (e)) and lag time (Dt). In the women of reproductive age, the inner myometrium displayed higher F and PS, lower V (b) and V (e), and longer Dt than the outer myometrium (p = 0.02, p = 0.01, p = 0.005, p = 0.03 and p = 0.01, respectively). The inner myometrium presented microvascular variations during the menstrual cycle with a pre-ovulatory peak followed by a fall reaching a nadir of F and V (b) about 4 days after ovulation. Compared with women of reproductive age, in the postmenopausal state, F and V (b) decreased in the outer myometrium, while PS, V (e) and Dt increased (p < 0.0001, p = 0.001, p = 0.001, p = 0.03 and p = 0.0004, respectively). DCE-MRI is a non-invasive technique that can measure variations of myometrial microcirculation, and thereby be potentially useful to help characterize the role and states of the myometrium in assisted reproductive therapy.