Uterine Artery Doppler Velocimetry of Uterine Leiomyomas in Nigerian Women

This was a prospective, case-control study conducted on 140 premenopausal women with sonographic diagnosis of uterine leiomyoma and 140 premenopausal controls without leiomyomas. Pelvic sonography was performed to diagnose and characterize the leiomyomas. The hemodynamics of the ascending branches of both main uterine arteries was assessed by Doppler interrogation. Statistical analysis was performed mainly using non-parametric tests.

Results

The median uterine volume of the subjects was 556 cm3, while that of the controls was 90.5 cm3 (p < 0.001). The mean peak systolic velocity (PSV), end-diastolic velocity (EDV), time-averaged maximum velocity (TAMX), time-averaged mean velocity (Tmean), acceleration time (AT), acceleration index (AI), diastolic/systolic ratio (DSR), diastolic average ratio (DAR), and inverse pulsatility index (PI) were significantly higher in the subjects (94.2 cm/s, 29.7 cm/s, 49.1 cm/s, 25.5 cm/s, 118 ms, 0.8, 0.3, 0.6, and 0.8 respectively) compared with the controls (54.2 cm/s, 7.7 cm/s, 20.0 cm/s, 10.0 cm/s, 92.0 ms, 0.6, 0.1, 0.4, and 0.4 respectively); p < 0.001 for all values. Conversely, the mean PI, resistivity index (RI), systolic/diastolic ratio (SDR) and impedance index (ImI) of the subjects (1.52, 0.70, 3.81, and 3.81 respectively) were significantly lower than those of the controls (2.38, 0.86, 7.23, and 7.24 respectively); p < 0.001 for all values.

Conclusion

There is a significantly increased perfusion of leiomyomatous uteri that is most likely due to uterine enlargement.

Keywords:
leiomyoma; uterine artery embolization; Doppler ultrasonography

Variable	Patients	Controls	Statistic	df	p
Variable	n = 140	n = 140	Statistic	df	p
Age in years
Mean ± SD*	37.9 ± 7.4	30.5 ± 8.3	7.9	278	< 0.001
n (%)**
< 20	0 (0.0)	13 (9.3)	46.0	4	< 0.001
20–29	18 (12.9)	51 (36.4)
30–39	68 (48.6)	56 (40.0)
40–49	45 (32.1)	18 (12.9)
≥ 50	9 (6.4)	2 (1.4)
Parity, n (%)
Nulliparous	79 (56.4)	70 (50.0)	2.3	3	0.5
Primiparous	21 (15.0)	19 (13.6)
Multiparous (2–4)	32 (22.9)	43 (30.7)
Grand multip. (> 4)	8 (5.7)	8 (5.7)
Weight (Kg)	66.8 ± 15.2	63.7 ± 16.0	1.7	278	0.1
Height (m)	1.61 ± 0.06	1.6 ± 0.1	-0.1	278	0.9
BMI (kg/m²)	25.7 ± 5.3	24.6 ± 6.1	1.7	278	1.0

Doppler indices	Subjects	Controls	p ^†
Doppler indices	n = 140	n = 140	p ^†
PSV (cm/s)	94.2 ± 39.3	54.2 ± 16.4	< 0.001
EDV (cm/s)	29.7 ± 19.1	7.7 ± 2.6	< 0.001
TAMX (cm/s)	49.1 ± 26.4	20.0 ± 7.2	< 0.001
Tmean (cm/s)	25.5 ± 16.4	10.0 ± 4.2	< 0.001
PI	1.5 ± 0.7	2.4 ± 0.4	< 0.001
RI	0.7 ± 0.1	0.9 ± 0.03	< 0.001
SDR	3.8 ± 1.6	7.2 ± 1.5	< 0.001
AT (ms)	117.9 ± 28.0	92.0 ± 22.8	< 0.001
AI	0.8 ± 0.3	0.6 ± 0.2	< 0.001
DSR	0.3 ± 0.1	0.1 ± 0.03	< 0.001
ImI	3.8 ± 1.6	7.2 ± 1.5	< 0.001
DAR	0.6 ± 0.2	0.4 ± 0.1	< 0.001
1/PI	0.8 ± 0.3	0.4 ± 0.1	< 0.001

Doppler indices	Uterine volume		p ^†
	≤ 200.0 cm³	> 200.0 cm³
	n = 14	n = 126
PSV (cm/s)	65.1 ± 14.6	97.4 ± 39.9	< 0.001
EDV (cm/s)	12.8 ± 5.7	31.6 ± 19.1	< 0.001
TAMX (cm/s)	23.8 ± 7.9	51.9 ± 26.2	< 0.001
Tmean (cm/s)	12.7 ± 4.7	26.9 ± 6.7	< 0.001
PI	2.4 ± 1.1	1.4 ± 0.6	< 0.001
RI	0.8 ± 0.1	0.7 ± 0.1	< 0.001
SDR	5.7 ± 1.7	3.6 ± 1.5	< 0.001
AT (ms)	98.5 ± 30.0	120.1 ± 27.1	0.01
AI	0.7 ± 0.3	0.8 ± 0.3	0.20
DSR	0.2 ± 0.1	0.3 ± 0.1	< 0.001
ImI	5.7 ± 1.7	3.6 ± 1.5	< 0.001
DAR	0.6 ± 0.3	0.6 ± 0.2	0.01
1/PI	0.5 ± 0.1	0.8 ± 0.3	< 0.001

Doppler indices	Menorrhagia		p ^†
Doppler indices	Present (n= 70)	Absent (n= 70)	p ^†
PSV (cm/s)	103.6 ± 39.5	84.8 ± 37.0	0.001
EDV (cm/s)	34.1 ± 19.0	25.3 ± 18.3	0.001
TAMX (cm/s)	55.4 ± 26.7	42.8 ± 24.7	0.001
Tmean (cm/s)	28.8 ± 14.5	22.2 ± 17.6	0.001
PI	1.4 ± 0.7	1.6 ± 0.7	0.03
RI	0.7 ± 0.1	0.7 ± 0.1	0.02
SDR	3.5 ± 1.3	4.1 ± 1.8	0.03
AT (ms)	116.2 ± 28.4	119.6 ± 27.7	0.37
AI	0.9 ± 0.3	0.7 ± 0.3	0.001
DSR	0.3 ± 0.1	0.3 ± 0.1	0.03
ImI	3.5 ± 1.3	4.1 ± 1.8	0.03
DAR	0.6 ± 0.3	0.6 ± 0.2	0.14
1/PI	0.8 ± 0.3	0.7 ± 0.3	0.03

Doppler indices	History of previous myomectomy		p ^†
Doppler indices	Present (n= 14)	Absent (n= 126)	p ^†
PSV (cm/s)	122.1 ± 62.7	91.1 ± 34.8	0.05
EDV (cm/s)	42.0 ± 32.4	28.3 ± 16.6	0.1
TAMX (cm/s)	63.9 ± 42.4	47.4 ± 23.7	0.2
Tmean	36.7 ± 30.6	24.3 ± 13.7	0.1
PI	1.4 ± 0.4	1.5 ± 0.8	0.9
RI	0.7 ± 0.1	0.7 ± 0.1	0.5
SDR	3.4 ± 0.9	3.9 ± 1.7	0.5
AT (mms)	126.7 ± 37.1	116.9 ± 26.8	0.5
AI	0.9 ± 0.3	0.8 ± 0.3	0.1
DSR	0.3 ± 0.1	0.3 ± 0.1	0.5
ImI	3.4 ± 0.9	3.9 ± 1.7	0.5
DAR	0.6 ± 0.1	0.6 ± 0.2	0.1
1/PI	0.8 ± 0.2	0.8 ± 0.3	0.9

Doppler indices	Subjects (n= 140)		Controls (n= 140)
Doppler indices	Correlation coefficient, r	p	Correlation coefficient, r	p
PSV (cm/s)	0.6	< 0.001	0.4	< 0.001
EDV (cm/s)	0.7	< 0.001	0.3	< 0.001
TAMX (cm/s)	0.7	< 0.001	0.4	< 0.001
Tmean(cm/s)	0.6	< 0.001	0.3	< 0.001
PI	−0.6	< 0.001	−0.3	< 0.001
RI	−0.5	< 0.001	−0.1	0.54
SDR	−0.5	< 0.001	−0.02	0.76
AT (ms)	0.3	< 0.001	0.4	< 0.001
AI	0.4	< 0.001	0.03	0.72
DSR	0.5	< 0.001	0.03	0.75
ImI	−0.5	< 0.001	−0.03	0.75
DAR	0.4	< 0.001	−0.2	0.01

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[1] Address for correspondence Bukunmi Michael Idowu, FEACS, FMCR, Department of Radiology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria (e-mail: ibmcontacts@gmail.com).