On sonoelastography, foci of adenomyosis are seen as brighter irregular shaped lesions (because of the presence of endometrial glands and stroma implanted within the myometrium), whereas fibroids are seen as well-delineated dark areas (secondary to stiffer/compressed smooth muscle fibers) [18,19]. Compression sonoelastography is a method of applying gentle compression causing alteration in size and shape of the lesion based on the tissue stiffness, which can be qualitatively (as a color map) or quantitatively recorded. Studies have shown high interobserver and intermethod agreement for the measurement of uterine and fibroid volumes on compression elastography [19] and excellent agreement between elastography-based diagnosis of fibroids and adenomyosis with MRI-based diagnosis [18]. The role of artificial intelligence in imaging fibroids is currently under investigation. There are several studies evaluating machine learning with textural analysis to improve the diagnostic accuracy of differentiating fibroids from sarcomas [20]. OR Discussion of Procedures by Variant Variant 1: Clinically suspected fibroids. Initial imaging. CT Pelvis There is no relevant literature to support the use of pelvic CT without or with intravenous (IV) contrast as initial imaging modality for clinically suspected fibroids. MRI Pelvis MRI excels at identifying and mapping fibroids [21-25]. When MRI is clinically useful, the use of a gadolinium- based IV contrast agent is preferred for identification of fibroid vascularity and other characteristics [26]. Please see the ACR Manual on Contrast Media for additional information [27]. Signal intensity and contrast enhancement allow diagnosis of fibroids to include size, number and location, and assessment of vascularity and to help characterize them as classic, degenerated (hyaline, carneous, hydropic, fatty, cystic, and myxoid), cellular, or atypical [28-30].
Fibroids. On sonoelastography, foci of adenomyosis are seen as brighter irregular shaped lesions (because of the presence of endometrial glands and stroma implanted within the myometrium), whereas fibroids are seen as well-delineated dark areas (secondary to stiffer/compressed smooth muscle fibers) [18,19]. Compression sonoelastography is a method of applying gentle compression causing alteration in size and shape of the lesion based on the tissue stiffness, which can be qualitatively (as a color map) or quantitatively recorded. Studies have shown high interobserver and intermethod agreement for the measurement of uterine and fibroid volumes on compression elastography [19] and excellent agreement between elastography-based diagnosis of fibroids and adenomyosis with MRI-based diagnosis [18]. The role of artificial intelligence in imaging fibroids is currently under investigation. There are several studies evaluating machine learning with textural analysis to improve the diagnostic accuracy of differentiating fibroids from sarcomas [20]. OR Discussion of Procedures by Variant Variant 1: Clinically suspected fibroids. Initial imaging. CT Pelvis There is no relevant literature to support the use of pelvic CT without or with intravenous (IV) contrast as initial imaging modality for clinically suspected fibroids. MRI Pelvis MRI excels at identifying and mapping fibroids [21-25]. When MRI is clinically useful, the use of a gadolinium- based IV contrast agent is preferred for identification of fibroid vascularity and other characteristics [26]. Please see the ACR Manual on Contrast Media for additional information [27]. Signal intensity and contrast enhancement allow diagnosis of fibroids to include size, number and location, and assessment of vascularity and to help characterize them as classic, degenerated (hyaline, carneous, hydropic, fatty, cystic, and myxoid), cellular, or atypical [28-30].