Post-Endometrial Ablation Complications: Evaluation and Management

Diagnostic Algorithm

• The American College of Radiology recommends pelvic MRI with diffusion-weighted imaging for evaluating post-ablation complications, as it provides superior soft-tissue characterization and can visualize the endometrium even in the presence of leiomyomas and post-ablation changes 1, 2
• Diffusion-weighted imaging improves sensitivity and specificity for detecting endometrial pathology and can help differentiate leiomyosarcoma from benign leiomyoma 1, 2
• MRI can identify adenomyosis with characteristic junctional zone thickening, and is superior for diagnosing this condition 1, 2
• The American College of Radiology suggests that diffusion-weighted MRI helps differentiate leiomyosarcoma from benign leiomyoma 1, 2
• In cases of free pelvic fluid, urgent investigation is required, as this finding combined with irregular uterine contour may indicate hematometra with retrograde flow, infection, or perforation 5