Preoperative uterine volume estimation: transvaginal ultrasound (TVUS) versus MRI (ellipsoid volume formula and 3D volumetry)

Dahila Amal Djema, Jean Dubuisson, Meriem Boukrid, Nicolas Villard, Anastasia Kalovidouri, Diomidis Botsikas


Purpose: Preoperative uterine volume estimation is a major consideration for surgeons as the choice of the optimal surgical approach between vaginal, laparoscopic or abdominal hysterectomy depends on uterine volume. Volume estimation can be done clinically, by ultrasound and magnetic resonance imaging (MRI) if available. The aim of this study was to compare the accuracy of different methods of preoperative uterine volume calculation including transvaginal ultrasound (TVUS) and MRI.

Material and Methods: Data of all women who underwent hysterectomy for a benign pathology between January 2013 and December 2015 and had preoperative TVUS and MRI were retrieved. Uterine volume was calculated by application of the ellipsoid volume formula (EVF) based on TVUS and MRI and also by freehand 3D MRI volumetry. Pathology was the standard of reference.

Results: Sixty-seven women were included in this retrospective study. For eight of them, TVUS measurements were not feasible, mainly due to the large size of the uteri. For the remaining 59 women, there was no difference between uterine weights (mean 384.2 g+/- 425.8) and volumes calculated by MRI based on EVF (mean 404.3 g +/- 477.5, p >0.9999), and by 3D MRI volumetry (mean 391.8g +/- 446.1, p>0.9999). The difference between the standard of reference and the volumes calculated by TVUS (mean 334.0 g +/- 370.6, p=0.0011) were statistically significant.

Conclusions: According to our results, preoperative uterine volume calculation is more accurately performed by means of MRI compared to TVUS. When available, uterine volume estimation should be obtained from MRI measurements. For this purpose, EVF can be safely used without the need of time-consuming 3D volumetry.


Uterus volumetry; Pelvic MRI; Transvaginal Ultrasound; Hysterectomy

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