Conventional MRI, however, cannot accurately differentiate fibroids from sarcomas, a critical distinction for surgical planning and optimizing outcomes [31-33]. Diffusion- weighted imaging with apparent diffusion coefficient (ADC), especially when incorporated into an MRI algorithm, has shown promising results in distinguishing the two entities [20,34-40]. In a large, case-controlled retrospective study of women with atypical uterine masses, a diagnostic algorithm based on enlarged lymph nodes, peritoneal implants, high diffusion MRI signal, and low ADC values was developed and validated. The resulting algorithm achieved a 98% sensitivity and a 96% specificity in the training set and 83% to 88% sensitivity and 97% to 100% specificity in the validation sets [34]. Machine learning with texture analysis is under investigation and may have the potential to improve diagnostic accuracy [20]. MRI can differentiate fibroids from alternative or comorbid conditions such as adenomyosis and endometriosis that often cause similar symptoms [41,42]. US Pelvis Transabdominal A combination of transabdominal US (TAUS) and TVUS of the pelvis is the most useful modality in the initial evaluation of suspected uterine fibroid or abnormal uterine bleeding [43-45]. TAUS is often useful in significantly Fibroids enlarged fibroid uterus or large subserosal/pedunculated fibroids that may render poor visualization on TVUS because of limited field-of-view from poor acoustic penetration. A potential limitation of TAUS is the poor acoustic window from decompressed urinary bladder, retroverted uterus, large body habitus, and bowel gas [46]. US Pelvis Transvaginal TVUS provides higher contrast and spatial resolution and should be combined with the TAUS whenever possible to evaluate suspected uterine fibroid [46,47]. TVUS has a reported sensitivity of 90% to 99% for detecting uterine fibroids and a sensitivity of 90% and specificity of 98% for the diagnosis of submucosal fibroids [43,48,49].
Fibroids. Conventional MRI, however, cannot accurately differentiate fibroids from sarcomas, a critical distinction for surgical planning and optimizing outcomes [31-33]. Diffusion- weighted imaging with apparent diffusion coefficient (ADC), especially when incorporated into an MRI algorithm, has shown promising results in distinguishing the two entities [20,34-40]. In a large, case-controlled retrospective study of women with atypical uterine masses, a diagnostic algorithm based on enlarged lymph nodes, peritoneal implants, high diffusion MRI signal, and low ADC values was developed and validated. The resulting algorithm achieved a 98% sensitivity and a 96% specificity in the training set and 83% to 88% sensitivity and 97% to 100% specificity in the validation sets [34]. Machine learning with texture analysis is under investigation and may have the potential to improve diagnostic accuracy [20]. MRI can differentiate fibroids from alternative or comorbid conditions such as adenomyosis and endometriosis that often cause similar symptoms [41,42]. US Pelvis Transabdominal A combination of transabdominal US (TAUS) and TVUS of the pelvis is the most useful modality in the initial evaluation of suspected uterine fibroid or abnormal uterine bleeding [43-45]. TAUS is often useful in significantly Fibroids enlarged fibroid uterus or large subserosal/pedunculated fibroids that may render poor visualization on TVUS because of limited field-of-view from poor acoustic penetration. A potential limitation of TAUS is the poor acoustic window from decompressed urinary bladder, retroverted uterus, large body habitus, and bowel gas [46]. US Pelvis Transvaginal TVUS provides higher contrast and spatial resolution and should be combined with the TAUS whenever possible to evaluate suspected uterine fibroid [46,47]. TVUS has a reported sensitivity of 90% to 99% for detecting uterine fibroids and a sensitivity of 90% and specificity of 98% for the diagnosis of submucosal fibroids [43,48,49].