Cine-MRI for Quantifying Uterine Peristalsis: A Systematic Review and Meta-Analysis.

Area of Science:

• Reproductive Medicine
• Medical Imaging
• Gynecology

Background:

• Uterine contractility, or uterine peristalsis (UP), is crucial for fertility, influencing sperm transport and embryo implantation.
• Elevated UP is linked to lower pregnancy rates, but data are inconsistent and clinical application is limited.
• Cine-MRI offers a promising method to study uterine dynamics and UP in various conditions.

Purpose of the Study:

• To systematically review and meta-analyze UP patterns in physiological and pathological uterine conditions using cine-MRI.
• To specifically investigate UP in endometriosis and fibroids.
• To describe UP dynamics in relation to the menstrual cycle.

Main Methods:

• Systematic literature search across major databases (Medline, Embase, Cochrane, CENTRAL) and Google Scholar up to May 2024.
• Inclusion of clinical studies evaluating uterine contractility via cine-MRI, excluding those with therapeutic interventions or unrelated pathologies.
• Meta-analysis focused on comparing uterine contractility in women with and without endometriosis.

Main Results:

• Thirteen studies involving 365 women were included, revealing significant variations in UP based on menstrual cycle phase and pathology.
• Meta-analysis indicated higher uterine contractility in the luteal phase for women with endometriosis (SMD 0.74; 95% CI: 0.27-1.21).
• No significant difference in UP was observed in the periovulatory phase for women with endometriosis (SMD 0.8; 95% CI: -3.78-5.37).

Conclusions:

• Cine-MRI is a valuable tool for analyzing uterine peristalsis.
• Endometriosis is associated with altered UP, potentially contributing to reduced implantation rates and infertility.
• Further research is needed to standardize UP assessment tools and clarify their impact on fertility and implantation.