 Although pelvic MRI protocols may vary somewhat between institutions, we specifically note that the addition of a diffusion-weighted imaging sequence is important in the MRI examination of the uterus in women with AUB. Diffusion-weighted imaging has been shown to improve the sensitivity and specificity of MRI for the accurate diagnosis of uterine pathology [14-16]. This has been most extensively studied in endometrial cancer; however, there is ongoing research in using diffusion-weighted imaging for differentiating leiomyosarcomas from benign leiomyomas [16-23]. MR angiography may be incorporated into the MRI protocol in the preprocedural workup of Reprint requests to: publications@acr.org Abnormal Uterine Bleeding leiomyomas prior to uterine artery embolization because the vascular anatomy serves as a road map for the interventional radiologist [24,25]. In the initial assessment of leiomyomas and other uterine pathologies, 3-D US may also be considered, because this technique has the potential to help with spatial assessment and treatment planning [26]. Research is ongoing to determine the clinical accuracy of 3-D US compared with 2-D US alone [27-29]. Three-dimensional US may increase the confidence of the diagnosis and be helpful when communicating with the referring physician on the location and size of uterine pathology [30,31]. US elastography measures tissue stiffness. Small studies have shown that, in combination with routine 2-D US, strain, elastography may increase the diagnostic accuracy of US in differentiating endometrial polyps from submucosal leiomyomas [32] and differentiating leiomyomas from adenomyosis [33]. OR Discussion of Procedures by Variant Variant 1: Abnormal uterine bleeding. Initial imaging. CT Pelvis To our knowledge, there is no relevant literature to support the use of CT pelvis in the initial imaging evaluation of AUB. MRI Pelvis To our knowledge, there is no relevant literature to support the use of MRI pelvis in the initial imaging evaluation of AUB.
Abnormal Uterine Bleeding.  Although pelvic MRI protocols may vary somewhat between institutions, we specifically note that the addition of a diffusion-weighted imaging sequence is important in the MRI examination of the uterus in women with AUB. Diffusion-weighted imaging has been shown to improve the sensitivity and specificity of MRI for the accurate diagnosis of uterine pathology [14-16]. This has been most extensively studied in endometrial cancer; however, there is ongoing research in using diffusion-weighted imaging for differentiating leiomyosarcomas from benign leiomyomas [16-23]. MR angiography may be incorporated into the MRI protocol in the preprocedural workup of Reprint requests to: publications@acr.org Abnormal Uterine Bleeding leiomyomas prior to uterine artery embolization because the vascular anatomy serves as a road map for the interventional radiologist [24,25]. In the initial assessment of leiomyomas and other uterine pathologies, 3-D US may also be considered, because this technique has the potential to help with spatial assessment and treatment planning [26]. Research is ongoing to determine the clinical accuracy of 3-D US compared with 2-D US alone [27-29]. Three-dimensional US may increase the confidence of the diagnosis and be helpful when communicating with the referring physician on the location and size of uterine pathology [30,31]. US elastography measures tissue stiffness. Small studies have shown that, in combination with routine 2-D US, strain, elastography may increase the diagnostic accuracy of US in differentiating endometrial polyps from submucosal leiomyomas [32] and differentiating leiomyomas from adenomyosis [33]. OR Discussion of Procedures by Variant Variant 1: Abnormal uterine bleeding. Initial imaging. CT Pelvis To our knowledge, there is no relevant literature to support the use of CT pelvis in the initial imaging evaluation of AUB. MRI Pelvis To our knowledge, there is no relevant literature to support the use of MRI pelvis in the initial imaging evaluation of AUB.