Three- dimensional TAUS and TVUS along with Doppler has shown high accuracy in differentiating uterine fibroids from adenomyosis with a sensitivity, specificity, and negative predictive value of 93%, 96%, and 88% for fibroids and 96%, 93%, and 98% for adenomyosis [50]. In a meta-analysis by Bittencourt et al [51], the pooled sensitivity and specificity of 2-D TVUS with SIS in diagnosing submucosal fibroids was 94% and 81%, respectively. The limitations of TVUS are a limited depth of penetration and a shallow focal length that can limit the evaluation of large or subserosal/pedunculated fibroids. US Duplex Doppler Pelvis Although Doppler imaging is labeled under separate imaging procedure per ACR methodology, this document considers it to be a standard component of pelvic US. Color Doppler is routinely used in pelvic US examinations to evaluate internal vascularity of pelvic/uterine findings and to differentiate between vascular and nonvascular tissue [47]. US duplex Doppler evaluation may also help in differentiating submucosal/intracavitary fibroids from endometrial polyps. Visualization of a vascular pedicle on transvaginal color Doppler imaging has a specificity of 95% to 98% and a negative predictive value of 81% to 94% for the detection of endometrial polyps [57,58]. Variant 2: Known fibroids. Treatment planning. Initial imaging. CT Pelvis There is no relevant literature to support the use of pelvic CT without or with IV contrast as initial imaging in treatment planning for symptomatic fibroids. CT, however, can better delineate calcified fibroids relative to US and MRI that may have treatment implications. MRI Pelvis MRI is superior to US (transabdominal followed by transvaginal) for identifying and mapping fibroids and may alter management in up to 28% of patients [22-25,59-61]. When MRI is clinically useful, the use of a gadolinium- based IV contrast agent is preferred [26]. Please see the ACR Manual on Contrast Media for additional information [27].
Fibroids. Three- dimensional TAUS and TVUS along with Doppler has shown high accuracy in differentiating uterine fibroids from adenomyosis with a sensitivity, specificity, and negative predictive value of 93%, 96%, and 88% for fibroids and 96%, 93%, and 98% for adenomyosis [50]. In a meta-analysis by Bittencourt et al [51], the pooled sensitivity and specificity of 2-D TVUS with SIS in diagnosing submucosal fibroids was 94% and 81%, respectively. The limitations of TVUS are a limited depth of penetration and a shallow focal length that can limit the evaluation of large or subserosal/pedunculated fibroids. US Duplex Doppler Pelvis Although Doppler imaging is labeled under separate imaging procedure per ACR methodology, this document considers it to be a standard component of pelvic US. Color Doppler is routinely used in pelvic US examinations to evaluate internal vascularity of pelvic/uterine findings and to differentiate between vascular and nonvascular tissue [47]. US duplex Doppler evaluation may also help in differentiating submucosal/intracavitary fibroids from endometrial polyps. Visualization of a vascular pedicle on transvaginal color Doppler imaging has a specificity of 95% to 98% and a negative predictive value of 81% to 94% for the detection of endometrial polyps [57,58]. Variant 2: Known fibroids. Treatment planning. Initial imaging. CT Pelvis There is no relevant literature to support the use of pelvic CT without or with IV contrast as initial imaging in treatment planning for symptomatic fibroids. CT, however, can better delineate calcified fibroids relative to US and MRI that may have treatment implications. MRI Pelvis MRI is superior to US (transabdominal followed by transvaginal) for identifying and mapping fibroids and may alter management in up to 28% of patients [22-25,59-61]. When MRI is clinically useful, the use of a gadolinium- based IV contrast agent is preferred [26]. Please see the ACR Manual on Contrast Media for additional information [27].