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Comparative Study
. 2015 Jan;22(1):15-22.
doi: 10.1177/1933719114553451. Epub 2014 Oct 20.

Unbiased and efficient estimation of the volume of the fibroid uterus using the Cavalieri method and magnetic resonance imaging

Michael J Thrippleton  1 , Kirsty I Munro  2 , Graham McKillop  3 , David E Newby  4 , Ian Marshall  5 , Neil Roberts  6 , Hilary O D Critchley  7
Affiliations
Comparative Study

Unbiased and efficient estimation of the volume of the fibroid uterus using the Cavalieri method and magnetic resonance imaging

Michael J Thrippleton et al. Reprod Sci. 2015 Jan.

Abstract

The aim of our study was to develop a reliable technique for measuring volume of the fibroid uterus using Magnetic Resonance Imaging. We applied the Cavalieri method and standard calliper technique to measure the volume of the uterus and largest fibroid in 26 patients, and results were compared with "gold-standard" planimetry measurements. We found Cavalieri measurements to be unbiased, while calliper measurements systematically underestimated uterine volume (- 13.2%, P < 10(-5)) and had greater variance. Repeatability was similar for the 2 techniques (standard deviation [SD] = 4.0%-6.9%). Reproducibility of Cavalieri measurements was higher for measurement of uterine (SD = 9.0%) than fibroid volume (SD = 19.1%), whereas the reproducibility of calliper measurements was higher for fibroid (SD = 9.1%) than uterine volume (SD = 15.9%). The additional measurement time for the Cavalieri method was approximately 1 to 2 minutes. In conclusion, the Cavalieri method permits more accurate measurement of uterine and fibroid volumes and is suitable for application in both clinical practice and scientific research.

Keywords: Magnetic Resonance Imaging; fibroid uterus; leiomyoma; volume estimation.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Sagittal (a) and axial-oblique (b) images showing callipers used to estimate uterine volume, labelled as described in the text. The calliper measurements shown are 103(L) × 115(S) × 97(LR) mm.
Figure 2.
Figure 2.
Five Cavalieri sections with point counting grids (the spacing between neighbouring points is 1.56 cm) used to calculate uterine volume using the imaging data shown in Figure 1. Yellow crosses indicate points within the uterus.
Figure 3.
Figure 3.
Comparison of methods for volume estimation of the uterus (a–c) and largest fibroid (d–f). (a) and (d) compare calliper volume estimates against gold-standard EPSR values, while (b) and (e) compare volumes obtained by the Cavalieri method against EPSR; lines of equality are shown. Error bars indicate ±2SD (predicted) for Cavalieri volumes. Error bars for EPSR measurements are not shown since the sampling errors are too small to be clearly visible; for calliper measurements, error bars cannot be displayed as the sampling error is unknown. Boxplots in (c) and (f) compare measurement times of the first observer for the 3 methods, for uterus and fibroid, respectively; the medians and ranges for the calculated measurement precision are also indicated. EPSR indicates exhaustive planimetric serial reconstruction; SD, standard deviation.
Figure 4.
Figure 4.
Comparison of repeat measurements of uterine (left column) and fibroid (right column) volume by Cavalieri (a–d) and calliper (e–h) methods. (a and b) and (e and f) compare measurements by the same observer, while (c, d) and (g, h) compare measurements by 2 different observers; lines of equality are shown.
See this image and copyright information in PMC

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