“FLOW VOID SIGN” on MRI: Differentiation of Uterine Leiomyomas from Other Solid Pelvic Masses

Imrana Masroor, Ayesha Walid, Shaista Afzal, Saira Naz Sufian, Saba Sohail




Objective: To assess the usefulness of demonstrating flow void sign on conventional MRI sequences in differentiating uterine leiomyomas from other solid pelvic masses which have same signal intensity to myometrium.

Methods: This descriptive study was conducted in the Department of Radiology, University Hospital, Karachi from April 2014 to May 2015. It comprised female patients of all ages who had Magnetic Resonance Imaging (MRI) pelvis with diagnosis of a solid appearing pelvic mass followed by surgery and histopathology at our institution. Flow void sign was described as demonstration of feeding vessels appearing as flow void between the uterine leiomyomas and uterus. Histopathology was taken as gold standard.

Results: Flow void sign was observed in 66 out of 73 pelvic masses on MRI. Out of 66 patients 65 were diagnosed histologically as leiomyomas. When the  flow void sign was seen on MRI and subsequent histopathology confirmed the diagnosis of leiomyoma. In all such cased the sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy of the flow void sign for diagnosing leiomyomas were calculated as 97% (65/67), 83% (65/66), 98% (65/66), 71% (65/67) and 95% (70/73), respectively.

Conclusion: Flow void sign is an important ancillary sign for the radiological diagnosis of leiomyoma on MRI and useful in differentiating leiomyoma from focal adenomyosis or ovarian tumors (fibromas) which show signal intensity similar to uterine leiomyomas.

Key Word: leiomyomas, Magnetic Resonance Imaging, Flow void sign, pelvic mass


Full Text:




Zimmermann A, Bernuit D, Gerlinger C, Schaefers M, Geppert K. Prevalence, symptoms and management of uterine fibroids: an international internet-based survey of 21,746 women. BMC Women’s Health. 2012; 26:12-6.

UrRehman I, UlHaq T, Hamid R.S, Azeemuddin M., Akhtar W, Kanwal D. Uterine Artery Embolization For The Treatment Of Uterine Fibroids: Initial Experience. PJR. 2011 ;21(1): 01-05.

Shaheen S, Naheed T, Sadaf F, Rahim R. Menorrhagia Due to Fibroids and its Management. JSOGP. 2013;3(4):231-35.

Allen BC, Hosseinzadeh K, Qasem SA, Varner A, Leyendecker JR. Practical approach to MRI of female pelvic masses. AJR Am J Roentgenol. 2014; 202(6):1366-75.

Park SB. Features of the hypointense solid lesions in the female pelvis on T2-weighted MRI. J Magn Reson Imaging. 2014;39(3):493-503.

Kim SH, Sim JS, Seong CK. Interface vessels on color/power Doppler US and MRI: a clue to differentiate subserosal uterine myomas from extrauterine tumors. J Comput Assist Tomogr. 2001;25(1):36-42.

Torashima M, Yamashita Y, Matsuno Y, Takahashi M, Nakahara K, Onitsuka Y et al. The value of detection of flow voids between the uterus and the leiomyoma with MRI. J Magn Reson Imaging. 1998; 8(2):427-31.

Weinreb JC, Barkoff ND, Megibow A, Demopoulos R. The value of MR imaging in distinguishing leiomyomas from other solid pelvic masses when sonography is indeterminate. AJR Am J Roentgenol. 1990 Feb;154(2):295-9.

Lee JH, Jeong YK, Park JK, Hwang JC. “Ovarian vascular pedicle” sign revealing organ of origin of a pelvic mass lesion on helical CT. AJR Am J Roentgenol. 2003 Jul;181(1):131-7.

Aggarwal BK, Panwar S, Rajan S, Aggarwal A, Ahlawat K. Varied appearances & signal characteristics of leiomyomas on MR imaging. Ind J Radiol Imaging. 2005;15(2):271-6.

Murase E, Siegelman ES, Outwater EK, Perez-Jaffe LA, Tureck RW. Uterine leiomyomas: histopathologic features, MR imaging findings, differential diagnosis, and treatment. Radiographics. 1999 Sep-Oct;19(5):1179-97.

Farrer-Brown G, Beilby JOW, Rawles PM. Microvasculature of the uterus. An injection method of study. Obstet Gynecol 1970: 35(1):21-30.

Pelage JP, Cazejust J, Pluot E, Le Dref O, Laurent A, Spies JB et al. Uterine fibroid vascularization and clinical relevance to uterine fibroid embolization. Radiographics. 2005 Oct;25 Suppl 1:S99-117.

Lang EK. Bladder and pelvic angiography. In: Abrams IIL. ed. Abrams angiography: vascular and interventional radiology, 3rd ed. Boston: Little, Brown and Company, 1983: 1753-1788.

Mittl RL Jr, Yeh IT, Kressel YH. High- signal-intensity rim surrounding uterine leiomyomas on MR images:pathologic correlation. Radiology 1991;180(1):81-3

Thomassin-Naggara I, Darai E, Nassar-Slaba J, Cortez A, Marsault C, Bazot M.Value of dynamic enhanced magnetic resonance imaging for distinguishing between ovarian fibroma and subserous uterine leiomyomas. J Comput Assist Tomogr.2007 Mar- Apr;31(2):236-42


  • There are currently no refbacks.

© Copyright PJR 2008-