In a meta-analysis of 14 studies including 1,898 women who had US for uterine pathology, the pooled sensitivity and specificity for TVUS for the diagnosis of adenomyosis were 82.5% and 84.6%, respectively [41]. However, detection of adenomyosis at TVUS may be limited if there is coexisting uterine pathology, such as leiomyomas. In one study, the sensitivity and specificity of TVUS for diagnosing adenomyosis in patients with and without leiomyomas were 33.3% and 78% and 97.8% and 97.1%, respectively [47]. US Sonohysterography US sonohysterography, also referred to as hysterosonography, can be used in the setting of AUB, particularly if the initial TVUS demonstrates a focal endometrial abnormality [48]. The technique involves transcervical injection of sterile fluid, such as saline, in combination with routine TVUS [10,49]. Although some authors describe transcervical injection of gel [37], sterile saline is currently the accepted standard endometrial contrast agent [49]. The literature supports the use of US sonohysterography as an examination to further characterize endometrial observations on TVUS [48-51]. Variant 2: Abnormal uterine bleeding. Follow-up imaging when original ultrasound is inconclusive or further imaging characterization is needed. 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. MRI Pelvis When MRI is performed, the use of a gadolinium-based intravenous (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, 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].
Abnormal Uterine Bleeding. In a meta-analysis of 14 studies including 1,898 women who had US for uterine pathology, the pooled sensitivity and specificity for TVUS for the diagnosis of adenomyosis were 82.5% and 84.6%, respectively [41]. However, detection of adenomyosis at TVUS may be limited if there is coexisting uterine pathology, such as leiomyomas. In one study, the sensitivity and specificity of TVUS for diagnosing adenomyosis in patients with and without leiomyomas were 33.3% and 78% and 97.8% and 97.1%, respectively [47]. US Sonohysterography US sonohysterography, also referred to as hysterosonography, can be used in the setting of AUB, particularly if the initial TVUS demonstrates a focal endometrial abnormality [48]. The technique involves transcervical injection of sterile fluid, such as saline, in combination with routine TVUS [10,49]. Although some authors describe transcervical injection of gel [37], sterile saline is currently the accepted standard endometrial contrast agent [49]. The literature supports the use of US sonohysterography as an examination to further characterize endometrial observations on TVUS [48-51]. Variant 2: Abnormal uterine bleeding. Follow-up imaging when original ultrasound is inconclusive or further imaging characterization is needed. 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. MRI Pelvis When MRI is performed, the use of a gadolinium-based intravenous (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, 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].