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Transperineal and endovaginal ultrasound for evaluating sub-urethral masses: A comparison to magnetic resonance imaging.

OBJECTIVES: To determine the effectiveness of pelvic floor ultrasonography (PFUS) in the detection and evaluation of sub-urethral masses, using Magnetic Resonance Imaging (MRI) as the reference standard.

METHODS: A retrospective analysis of ultrasound and MRI scans of all sub-urethral masses from one urogynecology clinic over a 14-year period (July 2006 to March 2020). All women were examined with two-dimensional perineal pelvic floor ultrasound (2D pPFUS) with or without three-dimensional endovaginal ultrasound (3D EVUS), using the Flex Focus 500 ultrasound or Pro Focus 2202 system (BK Medical, Herlev, Denmark). Intra-class correlation coefficients (ICC 3,1) were used to assess the agreement between PFUS imaging and MRI measurements.

RESULTS: Forty women underwent PFUS (3D EVUS and/or 2D pPFUS alone) and MRI. The agreement between PFUS and MRI for detecting a sub-urethral mass was 85% [95% CI 70.2% to 94.3%]). The ICC analysis showed good to excellent agreement for the distance between the sub-urethral mass and the bladder neck (ICC 3,1= 0.89, standard error measurement (SEM)=3.64 mm) and the largest diameter of the mass on MRI and 2D pPFUS (ICC 3,1=0.93, SEM=4.31mm). Good to excellent agreement was found for the distance between the sub-urethral mass and the bladder neck (ICC 3,1= 0.88, SEM= 3.48 mm) and the largest diameter of the mass on MRI and 3D EVUS (ICC 3,1= 0.94, SEM= 4.68 mm).

CONCLUSIONS: 2D pPFUS and 3D EVUS are useful in the imaging of sub-urethral masses. We have demonstrated that measurements of sub-urethral masses taken with PFUS and MRI do not differ significantly and can be used interchangeably dependent on availability and expertise. This article is protected by copyright. All rights reserved.

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