Additionally, US sonohysterography can confirm the diagnosis of endometrial atrophy. Although sonohysterography could be considered in the setting of a previously inconclusive US, there is no current evidence confirming this approach is helpful if the endometrium could not be visualized on conventional TVUS [28]. Variant 3: Abnormal uterine bleeding. Follow-up imaging when surveillance is appropriate given findings from the initial ultrasound. CT Pelvis To our knowledge, there is no relevant literature to support the use of CT pelvis for the reassessment or follow up imaging of AUB. Abnormal Uterine Bleeding MRI Pelvis When MRI is performed, the use of a gadolinium-based IV contrast agent is preferred. Please refer to the ACR Manual on Contrast Media for additional information [52]. The inclusion of diffusion-weighted sequences should also be strongly considered. In the case of assessing leiomyomas prior to treatment or for potential growth, MRI has been shown to have increased sensitivity and specificity for location and size, in addition to helping exclude the coexistence of a leiomyosarcoma [12,16,17,20,21]. MRI has a sensitivity of approximately 78% and specificity of nearly 93% for the diagnosis of adenomyosis, and it can be used in the reassessment of women with AUB to exclude adenomyosis [13,55]. US Duplex Doppler Pelvis Although it is rated as a separate imaging procedure per ACR methodology, this document considers Doppler imaging to be a standard component of pelvic US. US duplex Doppler evaluation of the vascularity of the endometrium can help identify vessels within endometrial polyps or cancer [30,56]. Currently, there are no definitive studies demonstrating whether Doppler can differentiate between benign and malignant endometrial lesions; however, research is ongoing [37,56,57]. US duplex Doppler evaluation of leiomyomas and adenomyosis can be performed; however, there are no definitive studies demonstrating Doppler can differentiate between these two entities [58].
Abnormal Uterine Bleeding. Additionally, US sonohysterography can confirm the diagnosis of endometrial atrophy. Although sonohysterography could be considered in the setting of a previously inconclusive US, there is no current evidence confirming this approach is helpful if the endometrium could not be visualized on conventional TVUS [28]. Variant 3: Abnormal uterine bleeding. Follow-up imaging when surveillance is appropriate given findings from the initial ultrasound. CT Pelvis To our knowledge, there is no relevant literature to support the use of CT pelvis for the reassessment or follow up imaging of AUB. Abnormal Uterine Bleeding MRI Pelvis When MRI is performed, the use of a gadolinium-based IV contrast agent is preferred. Please refer to the ACR Manual on Contrast Media for additional information [52]. The inclusion of diffusion-weighted sequences should also be strongly considered. In the case of assessing leiomyomas prior to treatment or for potential growth, MRI has been shown to have increased sensitivity and specificity for location and size, in addition to helping exclude the coexistence of a leiomyosarcoma [12,16,17,20,21]. MRI has a sensitivity of approximately 78% and specificity of nearly 93% for the diagnosis of adenomyosis, and it can be used in the reassessment of women with AUB to exclude adenomyosis [13,55]. US Duplex Doppler Pelvis Although it is rated as a separate imaging procedure per ACR methodology, this document considers Doppler imaging to be a standard component of pelvic US. US duplex Doppler evaluation of the vascularity of the endometrium can help identify vessels within endometrial polyps or cancer [30,56]. Currently, there are no definitive studies demonstrating whether Doppler can differentiate between benign and malignant endometrial lesions; however, research is ongoing [37,56,57]. US duplex Doppler evaluation of leiomyomas and adenomyosis can be performed; however, there are no definitive studies demonstrating Doppler can differentiate between these two entities [58].