Patients prefer TVUS to MRI for pelvic imaging

Providers often turn to transvaginal ultrasound (TVUS) and MRI when women are experiencing pelvic pain or abnormal uterine bleeding. Which of these imaging modalities is preferred among women? A team of researchers studied that exact topic, publishing their findings in Academic Radiology.

“Although ultrasound is usually the most appropriate initial imaging study for women with pelvic pain or abnormal uterine bleeding, MRI provides additional anatomic and functional information and, in some cases, may be the preferred initial (or only) test if the patient cannot tolerate TVUS,” wrote lead author Katherine E. Maturen, MD, MS, of the department of obstetrics and gynecology at the University of Michigan in Ann Arbor, and colleagues. “Each examination has distinct diagnostic utility, and the purpose of patient preference assessment is not simply to shift decision-making from physicians to patients, but to identify factors that impact testing experiences and patient-centered value in imaging.”

Fifty menopausal patients who were recently evaluated by TVUS or MRI and without history of gynecologic cancer or hysterectomy were included in the research population. A questionnaire was issued over the phone that had validated survey instruments including Uterine Fibroid Systems Quality of Life index, Testing Morbidities Index (TMI) and Wait Trade Off (WTO) for TVUS and MRI examinations.

“Patient experiences and preference in imaging are shaped by many forces including communication and comfort,” the authors wrote. “Any effort to improve patient experiences in pelvic imaging should be based on a deeper understanding of patient factors associated with the testing differences for TVUS and MRI.”

According to the results, patients preferred TVUS over MRI using the WTO metric. Patients would have been willing to wait an average of almost four weeks to avoid MRI versus almost three weeks to avoid ultrasound. The TMI metric showed patients reporting greater embarrassment during TVUS, but greater fear and anxiety before and during the for MRI. They also reported having greater mental and physical problems after MRI.

Physically inactive women rated TVUS more negatively and women with more severe symptoms, including loss of control of health and sexual dysfunction, rated MRI more negatively.

The authors noted that greater patient education, coaching and support during the imaging exam or change of protocol could improve patient experiences.

“As radiologists, we should deepen and expand our understanding of patients’ experiences in imaging if we seek to be partners in their care,” they concluded.