Background: Accurate mapping of uterine fibroids is pivotal for selecting the least invasive, fertility-preserving therapy. Ultrasonography, although first-line in Pakistan, is often limited by obesity, distorted uterine anatomy, and operator dependence. Pelvic magnetic resonance imaging (MRI) offers superior tissue contrast, yet local performance data are sparse. Objective: To determine the diagnostic accuracy of 1.5 T pelvic MRI for detecting and characterising uterine fibroids in Pakistani women and to examine how MRI-derived topology correlates with presenting symptoms and influences surgical planning. Methodology: This cross-sectional study was conducted from June 2022 to July 2023 and enrolled 75 women presenting with clinical suspicion of uterine fibroids. Standardized pelvic MRI scans were performed at District Headquarter Hospital, Chiniot, and Sheikh Zayed Medical College submucosal lesions (14.1 %) were strongly associated with heavy menstrual bleeding (p = 0.002), whereas large subserosal masses drove pressure symptoms. Degenerative change was present in 19.4 % of uteri. MRI incidentally detected adenomyosis or benign ovarian cysts in 16.7 % of women, prompting modification of the operative plan in every case. Conclusion: Pelvic MRI on widely available 1.5 T systems delivers near-perfect sensitivity and high reproducibility for fibroid detection in Pakistani practice, while providing granular topographic detail that directly alters management. Selective integration of MRI, particularly when ultrasound is equivocal or complex surgery is anticipated, can optimise patient-centred treatment pathways. Keywords: Uterine leiomyoma; magnetic resonance imaging; diagnostic accuracy; symptom correlation; Pakistan; cross-sectional study.
Gill et al. (Sat,) studied this question.