Role of Transvaginal Ultrasound and MRI in the Evaluation and Characterization of Gynaecological Pelvic Pathologies: A Clinico-Histopathological Correlation Study

IntroductionTransvaginal USG is the first-line imaging modality for evaluating female pelvic pathologies because of its accessibility and cost-effectiveness.However, indeterminate findings and operator dependence may limit its diagnostic accuracy.MRI, with its superior soft-tissue contrast and multiplanar capability, serves as an important complementary modality for lesion characterization and staging. AimTo compare the diagnostic performance of USG and MRI in the evaluation of female pelvic pathologies using clinical, surgical, and histopathological findings as the reference standard. Materials and methodsThis prospective study included 50 women (11-70 years) with clinically suspected pelvic pathology who were evaluated between July 2013 and April 2014.All patients underwent transabdominal and transvaginal USG with Doppler, followed by pelvic MRI on a 3.0-T scanner using standard T1-, T2-, diffusion-weighted, and contrast-enhanced sequences where indicated.Imaging findings were compared with histopathological findings, intraoperative findings, or clinical follow-up.Diagnostic accuracy parameters and Cohen's kappa were calculated. ResultsFibroids were the most common pathology (26%), followed by cervical carcinoma (16%) and endometrial carcinoma (10%).MRI reduced the proportion of indeterminate lesions from 12% on USG to 2% and accurately identified the organ of origin in nearly all cases.MRI demonstrated 100% sensitivity and specificity for fibroids, adenomyosis, dermoid cysts, simple cysts, and endometriotic cysts, whereas USG showed lower sensitivity for fibroids (84.6%), dermoid cysts (50%), and the three malignant pathologies evaluated (cervical, endometrial, and ovarian carcinoma; USG sensitivity, 75-80%; MRI sensitivity, 100%).Agreement between modalities ranged from good to perfect (κ = 0.648-1.000),with very good agreement for fibroids (κ = 0.891) and malignant lesions (κ = 0.834-0.878). ConclusionMRI showed numerically higher diagnostic accuracy and improved lesion characterization compared with USG, particularly for complex pelvic lesions and equivocal ultrasound findings, although these differences were not evaluated using a formal paired statistical comparison.While USG remains the preferred first-line investigation, MRI is an invaluable complementary modality that improves diagnostic confidence and facilitates optimal clinical management.