Scientific Session 04 — Genitourinary - Reproductive/EndocrineMonday, May 1, 2017
2814. Understanding Patient Preference in Female Pelvic Imaging: Transvaginal Ultrasound and MRI
Sakala M*, Carlos R, Mendiratta-Lala M, Maturen K. University of Michigan, Ann Arbor, MI
Address correspondence to M. Sakala (firstname.lastname@example.org)
Objective: Women with pelvic pain and bleeding frequently undergo diagnostic imaging to identify underlying causes of their sometimes chronic and debilitating symptoms. The purpose of this study is to evaluate patient experience in transvaginal ultrasound (TVUS) and MRI and to explore correlations between preference and symptom severity.
Materials and Methods: Institutional review board approval was obtained for this HIPAA-compliant, prospective study. Included patients were at least 18 years old, were premenopausal, had pelvic pain or abnormal uterine bleeding, had no prior gynecologic cancer or hysterectomy, and had undergone both MRI and TVUS within a 6-month period. Patients completed a telephone questionnaire using validated survey instruments including the Uterine Fibroid Symptoms Quality of Life index, Testing Morbidities Index (TMI), and Wait Trade Off (WTO) questions for both TVUS and MRI examinations.
Results: Fifty women were included. Using WTO, patients rated MRI less favorably than TVUS (3.58 vs 2.80 wk; 95% CI, –1.63 to 0.12; p = 0.08). Summary test utility of TMI for MRI was also less favorable than TVUS (81.64 vs. 87.42; 95% CI, 0.41–11.15; p = 0.03). Patients reported greater embarrassment during TVUS than MRI (p < 0.0001) but greater fear and anxiety both before (p < 0.0001) and during the MR examination (p < 0.001) and greater mental (p = 0.02) and physical (p = 0.02) problems after the MR examination compared with TVUS. Subscale correlations were explored and women who were relatively inactive rated TVUS more negatively (R = –0.32, p = 0.03), and women with more severe symptoms of loss of control of health (R = –0.28, p = 0.04) and sexual dysfunction (R = –0.30, p = 0.03) rated the MR examination more negatively.
Conclusion: Women with pelvic pain, bleeding, or both had a slight but significant preference for TVUS over MRI. Identifying specific problematic elements of each type of imaging examination, as well as patient factors contributing to negative perceptions of imaging, provides a roadmap for improvement in both imaging technology and environment and patient education and preparation. Improved patient experience, in turn, may increase value of imaging for patients.