Magnetic resonance elastography (MRE) for the evaluation of fibrosis in patients with benign uterine disorders: a systematic review

OBJECTIVE: To review magnetic resonance elastography (MRE) techniques and evaluate the feasibility of quantifying the extent of fibrosis in patients with benign uterine disorders. MATERIALS AND METHODS: A systematic search of the MEDLINE and EMBASE databases was performed for identifying relevant articles published between January 1, 2007, and September 2025. Studies meeting predefined inclusion criteria were selected. Two independent reviewers extracted data on study design, patient population, MRI protocol characteristics, MRE parameters and MRI/MRE features. Mean stiffness (kPa), including standard deviation were either extracted or calculated. The same reviewers also assessed the methodological quality of each study. RESULTS: Six studies comprising a total of 162 patients (mean age range: 40.5 to 49 years) were included. Five studies focused on stiffness measurements in leiomyomas, while one study investigated the feasibility of stiffness measurements in patients with adenomyosis. All studies were classified as either pilot or feasibility studies. In studies reporting reproductive status, most patients were premenopausal (89 out of 125). The mean stiffness in evaluating leiomyomas ranged from 3.02 to 7.10 kPa across the included studies, resulting in a pooled mean stiffness of 4.72 ± 1.83 kPa. Uterine stiffness was higher in women with adenomyosis (2.93 kPa; range, 2.34-3.39 kPa) than in the healthy volunteer (2.04 kPa). Two studies correlated stiffness measurements with histopathological findings of fibrosis. All included studies were rated as having good methodological quality. CONCLUSIONS: Despite the small number of studies, current findings suggest that MRE is a feasible imaging modality for measuring fibrosis.