MRI has a sensitivity of approximately 78% and specificity of nearly 93% for the diagnosis of adenomyosis, and it can be used in the reassessment of women with AUB to exclude adenomyosis [13,55]. Abnormal Uterine Bleeding US Duplex Doppler Pelvis Although it is rated as a separate imaging procedure per ACR methodology, this document considers Doppler imaging to be a standard component of pelvic US. US duplex Doppler evaluation of the vascularity of the endometrium can help identify vessels within endometrial polyps or cancer [30,56]. Currently, there are no definitive studies demonstrating whether Doppler can differentiate between benign and malignant endometrial lesions; however, research is ongoing [37,56,57]. US duplex Doppler evaluation of leiomyomas and adenomyosis can be performed; however, there are no definitive studies demonstrating Doppler can differentiate between these two entities [58]. US Pelvis Transabdominal A combined transabdominal and transvaginal approach is most appropriate for pelvic US imaging. Transabdominal US is most helpful in the case of an enlarged uterus or uterine tumor, in which the limited field-of-view of TVUS cannot image all portions of the uterus or uterine tumor. US Pelvis Transvaginal If the initial imaging and clinical evaluation (eg, endometrial sampling) of women with AUB are negative, endometrial cancer in these women is extremely unlikely [10]. Nonetheless, repeat TVUS can be performed to reassess the endometrium, because endometrial cancers may be missed on initial imaging or endometrial sampling [59]. If on repeat imaging, the endometrium remains <4 mm in a postmenopausal woman, the negative predictive value for cancer is nearly 100% [10]. 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].
Abnormal Uterine Bleeding. MRI has a sensitivity of approximately 78% and specificity of nearly 93% for the diagnosis of adenomyosis, and it can be used in the reassessment of women with AUB to exclude adenomyosis [13,55]. Abnormal Uterine Bleeding US Duplex Doppler Pelvis Although it is rated as a separate imaging procedure per ACR methodology, this document considers Doppler imaging to be a standard component of pelvic US. US duplex Doppler evaluation of the vascularity of the endometrium can help identify vessels within endometrial polyps or cancer [30,56]. Currently, there are no definitive studies demonstrating whether Doppler can differentiate between benign and malignant endometrial lesions; however, research is ongoing [37,56,57]. US duplex Doppler evaluation of leiomyomas and adenomyosis can be performed; however, there are no definitive studies demonstrating Doppler can differentiate between these two entities [58]. US Pelvis Transabdominal A combined transabdominal and transvaginal approach is most appropriate for pelvic US imaging. Transabdominal US is most helpful in the case of an enlarged uterus or uterine tumor, in which the limited field-of-view of TVUS cannot image all portions of the uterus or uterine tumor. US Pelvis Transvaginal If the initial imaging and clinical evaluation (eg, endometrial sampling) of women with AUB are negative, endometrial cancer in these women is extremely unlikely [10]. Nonetheless, repeat TVUS can be performed to reassess the endometrium, because endometrial cancers may be missed on initial imaging or endometrial sampling [59]. If on repeat imaging, the endometrium remains <4 mm in a postmenopausal woman, the negative predictive value for cancer is nearly 100% [10]. 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].