Of these, myomectomy and UFE are the most common, and in a recent multicenter, randomized, open-label trial comparing myomectomy to UFE, both therapies resulted in equivalent symptomatic improvement at 2 years [8]. Special Imaging Considerations Saline infusion sonohysterography (SIS), a minimally invasive procedure distending the endometrial cavity with saline, enables better delineation between endometrial pathologies (polyps, hyperplasia, synechiae, etc) and submucosal fibroids. Studies have shown an overall good agreement (kappa 0.80) between 3-D SIS and diagnostic hysteroscopy to classify submucosal fibroids [9,10]. SIS has also been shown to accurately depict the percentage intracavitary component of submucosal fibroids, a finding that often has treatment implications [11,12]. Three-dimensional transvaginal ultrasound (3-D TVUS) is a reconstruction of the US volumetric data into high- resolution multiplanar imaging, including real-time surface rendered images [13]. In initial assessment, 3-D US has been used along with 2-D US for uterine pathologies, mostly submucosal fibroids, and endometrial polyps. A study of 139 cases comparing 3-D US against hysteroscopy in diagnosing uterine cavity abnormalities showed a sensitivity and specificity of 87% and 100% in diagnosing submucosal leiomyoma [14]. However, another study showed no significant advantage of 3-D US over 2-D US in estimating intracavitary protrusion of submucosal Reprint requests to: publications@acr.org Fibroids fibroid with a reference standard of hysteroscopy and a moderate interobserver agreement of 3-D US for submucosal fibroid [15]. US elastography/sonoelastography is a technique that measures tissue strain. Strain elastography used with routine TVUS has shown increased diagnostic accuracy in identifying myometrial pathologies (fibroids and adenomyosis) from normal myometrium [16,17].
Fibroids. Of these, myomectomy and UFE are the most common, and in a recent multicenter, randomized, open-label trial comparing myomectomy to UFE, both therapies resulted in equivalent symptomatic improvement at 2 years [8]. Special Imaging Considerations Saline infusion sonohysterography (SIS), a minimally invasive procedure distending the endometrial cavity with saline, enables better delineation between endometrial pathologies (polyps, hyperplasia, synechiae, etc) and submucosal fibroids. Studies have shown an overall good agreement (kappa 0.80) between 3-D SIS and diagnostic hysteroscopy to classify submucosal fibroids [9,10]. SIS has also been shown to accurately depict the percentage intracavitary component of submucosal fibroids, a finding that often has treatment implications [11,12]. Three-dimensional transvaginal ultrasound (3-D TVUS) is a reconstruction of the US volumetric data into high- resolution multiplanar imaging, including real-time surface rendered images [13]. In initial assessment, 3-D US has been used along with 2-D US for uterine pathologies, mostly submucosal fibroids, and endometrial polyps. A study of 139 cases comparing 3-D US against hysteroscopy in diagnosing uterine cavity abnormalities showed a sensitivity and specificity of 87% and 100% in diagnosing submucosal leiomyoma [14]. However, another study showed no significant advantage of 3-D US over 2-D US in estimating intracavitary protrusion of submucosal Reprint requests to: publications@acr.org Fibroids fibroid with a reference standard of hysteroscopy and a moderate interobserver agreement of 3-D US for submucosal fibroid [15]. US elastography/sonoelastography is a technique that measures tissue strain. Strain elastography used with routine TVUS has shown increased diagnostic accuracy in identifying myometrial pathologies (fibroids and adenomyosis) from normal myometrium [16,17].