Following technically successful UFE, >90% fibroid infarction on postcontrast imaging correlates with better symptom control and fewer reinterventions [88]. Fibroid location after treatment is also important, especially in cases of suspected fibroid expulsion, which occurs in 2.2% to 7.7% of cases [1,25,66]. Fibroids Specifically, intracavitary devascularized fibroid location predisposes to fibroid expulsion. Several studies show an association between diffusion-weighted imaging and ADC values and fibroid devascularization after UFE and MRgFUS [89-94]. Quantitative perfusion parameters have also been used to predict immediate MRgFUS ablation response [95]. US Pelvis Transabdominal A combination of TAUS and TVUS of the pelvis is a frequently used imaging modality in surveillance and posttreatment follow-up of known uterine fibroids [77,78]. TAUS is often useful in significantly enlarged fibroid uterus or large subserosal/pedunculated fibroids that can have poor visualization on TVUS because of limited field- of-view from poor acoustic penetration. Another potential limitation of TAUS is a poor acoustic window from decompressed urinary bladder, retroverted uterus, large body habitus, and bowel gas [46]. US Duplex Doppler Pelvis Although labeled under separate imaging procedure per ACR methodology, this document considers Doppler imaging to be a standard component of pelvic US. Color Doppler has been routinely used in pelvic US examinations to evaluate internal vascularity of pelvic/uterine findings and differentiate between vascular and nonvascular tissue [47]. UFE results in a marked reduction in fibroid size and disappearance of intrafibroid vascularity without a reduction in uterine vascularization that can be assessed with Doppler US [100].
Fibroids. Following technically successful UFE, >90% fibroid infarction on postcontrast imaging correlates with better symptom control and fewer reinterventions [88]. Fibroid location after treatment is also important, especially in cases of suspected fibroid expulsion, which occurs in 2.2% to 7.7% of cases [1,25,66]. Fibroids Specifically, intracavitary devascularized fibroid location predisposes to fibroid expulsion. Several studies show an association between diffusion-weighted imaging and ADC values and fibroid devascularization after UFE and MRgFUS [89-94]. Quantitative perfusion parameters have also been used to predict immediate MRgFUS ablation response [95]. US Pelvis Transabdominal A combination of TAUS and TVUS of the pelvis is a frequently used imaging modality in surveillance and posttreatment follow-up of known uterine fibroids [77,78]. TAUS is often useful in significantly enlarged fibroid uterus or large subserosal/pedunculated fibroids that can have poor visualization on TVUS because of limited field- of-view from poor acoustic penetration. Another potential limitation of TAUS is a poor acoustic window from decompressed urinary bladder, retroverted uterus, large body habitus, and bowel gas [46]. US Duplex Doppler Pelvis Although labeled under separate imaging procedure per ACR methodology, this document considers Doppler imaging to be a standard component of pelvic US. Color Doppler has been routinely used in pelvic US examinations to evaluate internal vascularity of pelvic/uterine findings and differentiate between vascular and nonvascular tissue [47]. UFE results in a marked reduction in fibroid size and disappearance of intrafibroid vascularity without a reduction in uterine vascularization that can be assessed with Doppler US [100].