Fibroids, MRI Resonance and CT Scan

Many patients want to remove the uterus with the excuse that “Until we open you, we will know how the fibroid is.” But, in truth, we do not explain how it is possible in the current era, with access to MRIs and 3D tomography! …That a doctor can say he doesn’t know what he’s facing.

#KnowledgeIsSuccess and in this video Dr. Arturo Valdés, Creafam fertility expert, explains to us how using CT and MRI the diagnosis of an intramural cystic fibroid and other subserous fibroids is made, the type of incision and procedure to be performed is planned and the whether the uterus can be saved or not, all days before performing the surgery.

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Introduction: MRI Resonance and CT Tomography

Look, we have a very important issue: both foreign patients from here in the Mexican Republic and foreign patients from other countries, whenever they write to us they tell us “It’s just that they told me that I had to remove my uterus” including those from Colombia and one of the USA, they send them to the oncologist surgeon. Sometimes we don’t understand because then they tell me “How do you know you are going to do surgery or that it is intramural?” Using ultrasound it is very difficult although there are times when we can determine it, but since the tomography generally has the ability to define where that tumor is located and say if it is intramural or subserous, it is very large, so it is not “until we open” that we We give an idea of how this surgery is going, because the doctors almost always mention that “No, until we open we will know” so the images are of no use and really no, the tomography and the MRI give us a perfect identification of the plans and can help us define the type of cut or incision that we are going to make and the risk of whether or not to remove the uterus, but generally once we make the incision we determine it precisely by some images to say: “Hey, this fibroid is intramural subserous” and then I’m going to make a median incision or a pfannenstiel incision, but we already know how we are going to approach this patient and we already know what type of tumors there are and we even know more or less the surgical time that It will require surgery depending on the characteristics of that tumor. So the tomography and MRI do define what type of fibroid they are and do define what type of surgery we need and also give us a prognosis of what surgical risk there is, as well as bleeding.

About this patient with uterine fibroids

This patient first wrote to us from the USA, from California, with a large fibroid that exceeded the umbilical scar and obviously they had told her there in the USA that they were going to remove her uterus, that it no longer made sense to leave it, but then at See the videos he wrote to us and wanted to show you. Generally, personally, we always ask for a tomography or an MRI, they are very similar studies, the MRI is simply a little clearer, the images… It is more pixelated so to speak, but both are very useful to us and within the CT and the resonance, there is the simple CT or the contrast one. The contrast helps even more to delimit the tumors, then you will see the images that we are going to upload, but it is very important to know that for us, since they send us a virtual consultation via Zoom, if we already have these images we give ourselves guidance very large, and if we do not send them to be able to explain to the patient the type of surgery, the surgical risk and most importantly: The possibility of preserving the uterus, which is what the patient generally seeks. So I’m going to show you here, this is the patient’s.

Generally there are two types of cuts: The sagittal cut and the longitudinal cut. This is a longitudinal cut, which what it does is make little slices from top to bottom or from bottom to top depending on how we see it, and what the sagittal cut does is make cuts from the shoulder and makes cuts, cuts to the back. middle and then it goes to the other side, but personally I like the sagittal cut better because I can visualize what it looks like here, see here is the spine, so I can see from more or less the hip, which is the head of the femur, see where the uterus begins or where it ends and thus determine if it is intramural, subserous or both components, then look, I’m going to show you.

This is not the patient from Colombia, but the Colombian patient had a tumor very similar to the MRI, the tomography, and in the first image that the gynecologist saw, she told her that she had to remove her uterus because she couldn’t see the uterus, but then look. the importance of doing a tomography. Here we are seeing the spine, the entire tumor, all the tumors it has, but if I move the spine or if I move the sagittal section in various directions I will begin to find the uterus, that is, this part here that can be seen here, this is the uterus and the uterine cavity, so this uterus or this fibroid is on the anterior surface, it moves all the way up and because of these semi-irregular characteristics, we pretend that it is a cyst… Or a cystic degenerated fibroid , but also in the ultrasonographic examination here it is going to help us, because they are seen as images in gaps that we call them. But in a tomography the advantage we have is that we can rotate or raise or lower the cuts and then give ourselves an adequate assessment of where the uterus is.

Study fibroids without surgery: 3D Tomography or MRI

Look then, we wanted to show you, I had already told you about a program that we downloaded to see the same image of the tomography but three-dimensional ourselves and that is going to give us an orientation, see, this is a cut between sagittal and frontal but I wanted to show you why It starts like the thigh of the leg, this would be the pubis, this is the abdomen and here is the umbilical incision, look at the umbilical scar and this part here is as if we did not cut from the hip. So what do we do with these types of patients? Well then we visualize all the images to be able to have a better idea, if I am going to drag it, see here is the head of the femur, the femur goes down here, this is the part of the tail, then we are making the cut, we are moving , we are moving, the spine appears and here is the tumor, see, here you see the tumor, that tumor moves upward because remember that this surgery had a tumor and above it had two other fibroids.

The most important thing about this is that with all the technology we have we can give ourselves a very big idea. Here is the uterus, see, here is the uterine cavity, then this is the column, here it descends, comes the sacrum and comes the coccyx and this is the sigmoid rectum, but here is the cervix and then this is the uterus and we know perfectly well that It is on the anterior surface and also moves upward but does not involve almost anything in the posterior surface of these uterine muscles. So, when we see this type of surgery or tumors, what we identify is: Here is the umbilical scar, so many times I tell the patient that the limit is the scar, above the umbilical scar we generally make a middle cut of the navel towards the pubis more or less 8 or 10 centimeters because the separator makes a gap of approximately 20 centimeters and we can maneuver perfectly, you will see it in the surgery.

So, when we have this type of images, the decision of mid or pfannenstiel surgery, which is the one in the bikini line, depends a lot on the size of the tumor or tumors that we have, or if they are subserosal or intramural, in The patient from Colombia had a fibroid that went above the scar, but seeing that it was completely subserous, we did make a pfannenstiel aesthetic incision, which is in the bikini line because we were not going to struggle to make the resection. Not in this patient, in this one we had to have a larger field because it was not a subserous fibroid but rather an intramural fibroid with a little bit of subserosal components. So, the most important thing is: Imaging does serve us for the surgical approach and for the prognosis of that patient, beforehand, that is, informing them what we are going to do, how long it will last and what risks we have. We should not stay with the idea that they tell us that because if it is large, the uterus has to be removed, because in many cases, like the one in Colombia, it was pure subserous, then this fibroid is intramural but has more of an outward component. that went to the uterine muscle and they will see it in surgery.

Miomectomy or uterine fibroid surgery

Good afternoon, look we want to introduce you to this fibroid, this is a hyaline degenerated cystic fibroid, see how watery it is, it is huge, about 25 cm. The 46-year-old patient who comes from California, she saw us in her videos and obviously they wanted to remove her uterus, this tumor really requires a hysterectomy on many occasions. We are going to first begin to resect this tumor and see if the uterus is salvageable, because at 46 years old she already has a living child, it is not so essential to preserve the uterus, but it is a completely cystic fibroid, now we are going to show it.

Look at this tumor, it is a relatively tumor, approximately 30 cm. very irregular, see how watery it is, but it’s already out, now we’ll see the others. Ready, look we’ve finished it, the cystic tumor weighed 1,800, the two large fibroids and two fibroids with small elements, obviously this one is going to go to pathology to see what histological origin it has.

It is a surgery that we thought was going to take more hours and it only took us an hour and a half and I didn’t bleed even 200 milliliters, so please call us, write to us, we can do a consultation via zoom initially, I would ask you for this study And if you already have it, send it to me and with this we can plan your surgery, even if you come from California, Dallas, we are going to have this month, from Colombia, from Peru, from Ecuador, we have already had many consultations and many surgeries from patients outside of Mexico, fortunately.

“We can solve the problem and above all preserve fertility by leaving the uterus”

Dr. Arturo Valdés
Dr. Arturo Valdés
Reproductive Medicine and Gynecological Endocrinology
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