Cine-MRI Research Of Uterine Peristalsis

Part 1 An Optimized Approach to Cine Imaging of Uterine Peristalsis on 3.0 T MRPurpose:To determine the optimal slice thickness, image playback rate, scan time and repetition time (TR) for cine magnetic resonance imaging (MRI) of uterine endometrial peristalsis on the 3.0 T MR scanner.Materials and Methods:The study was approved by the local ethics committee and informed consents from all the subjects were obtained. Thirty-one young female volunteers underwent 3-Tesla uterine cine MRI at their periovulatory phase. Twenty-three of them served as the study group (age range:23-28 years; mean:25 years). A midsagittal section of their uteri was scanned using a single-shot turbo spin echo (SSH-TSE) sequence with different slice thicknesses (3 mm (Cine3mm),5 mm (Cine5mm) and 7 mm (Cine7mm)) and two kinds of TR (2 s (Cine2s),4 s (Cine4s)) for 6 min each. Subjective image quality of those MR images with different thicknesses and TR was scored by two radiologists independently. Signal-to-noise ratios (SNRs) and contrast-to-noise ratios (CNRs) of the MR images were calculated and compared. The cine MR images of different thicknesses were played at image viewing rates of 8×,12×, and 15× the actual speed respectively and that cine MR images of different TR were played at image viewing rates of 12× the actual speed. The number, intensity, and direction of uterine peristalsis were assessed. Also, the peristalsis frequency per minute of different thickness was counted and compared at 15X the actual speed during different acquisition times (1-6 min).Results:The subjective image quality score of Cine7mm and Cine5mm were significantly higher than that of Cine3mm (P< 0.05) while the SNRs and CNRs of Cine7mm were significantly higher than those of Cine3mm (P< 0.05). The number and intensity of peristalsis of Cine7mm and Cine5mm were significantly higher than those of Cine3mm (P< 0.05). There was no significant difference between Cine2s and Cine4s in the subjective image quality score and peristalsis intensity (P> 0.05). Except CNR outer myometrium-JZ, the SNRs and CNRs of Cine4s were higher than Cine2s, but only difference in SNR endometrium and CNR endometrium-JZ was very significant (P< 0.05). In addition, peristalsis number of Cine4s was significantly higher than that in Cine2s (P< 0.05).There were no significant differences in peristalsis numbers at 8 ×,12×,and 15 × the actual speed for images with the same slice thickness (P>0.05).However, peristalsis intensity at 12×,and 15× the actual speed was significantly higher than that at 8× the actual speed for Cine7mm and Cine5mm (P< 0.05). The peristalsis direction of cervix-fundus (CF) was observed in 22 cases and an inverse wave (fundus-cervix) in 1 case. The peristalsis frequency at 3 min,4 min,5 min,6 min was significantly higher than at 1 min and 2 min (P< 0.05).Conclusion:On the 3.0 T MR scanner, Cine5mm and Cine7mm using image playback rates of 12 × and 15 × the actual speed can effectively display the number, intensity, and direction of endometrium peristalsis. In comparison to Cine4s, Cine2s can observe more peristaltic wave.Also, a scan time of 3 min is adequate for accurate counting of the peristalsis frequency.Part 2 the Cine MRI Research of Endometrial Peristalsis on Infertility Caused by Adenomyosis and Intrauterine AdhesionsPurpose:To study uterine peristalsis situation of infertility female caused by adenomyosis and intrauterine adhesions, (IU4), and compare their difference from normal uterine peristalsis, and provide a possible explanation mechanism for infertility of adenomyosis and intrauterine adhesion.Materials and Methods:The research got local ethics committee approval and informed consents were obtained from all patients.14 female infertility patients (8 patients with adenomyosis (age range:30-38 years old; average age:33 years),6 patients with intrauterine adhesions (age range:22- 33 years old; average age:26 years)) underwent 3.0 T uterine cine MR imaging at their preovulatory phase. A midsagittal section of their uteri was scanned using a single-shot turbo spin echo (SSH-TSE) sequence for 6 min each. The cine MR images were played at image viewing rates of 12×the actual speed, generating avi files. The number, intensity, and direction of uterine peristalsis were assessed by two radiologists respectively, and comparing with the normal volunteers with corresponding parameters.Results:The peristaltic number and intensity of patients with adenomyosis and intrauterine adhesions were significantly lower than those of normal volunteers. But the peristaltic direction of patients with adenomyosis was consistent with the normal group, while the uterine peristaltic direction of patients with intrauterine adhesions changed, only 41.18% normal cervix-fundus (CF) waves, with more than half of the reverse peristaltic waves.Conclusion:Adenomyosis and intrauterine adhesions can cause the reduction of the uterine peristaltic number and the intensity of peristalsis weakened, and intrauterine adhesions will result in reversal peristaltic direction. These changes of dynamic aspects may be an explanation mechanism of causing infertility or abortion.