Diagnostic Imaging for Uterine Fibroids

First-Line Imaging Modalities

The American College of Radiology recommends pelvic ultrasound (transabdominal and transvaginal) with Doppler as the initial diagnosis of fibroids, providing high sensitivity and specificity for detecting uterine fibroids 1, 2
Transvaginal ultrasound (TVUS) provides higher contrast and spatial resolution and should be combined with transabdominal ultrasound whenever possible, demonstrating high sensitivity (90-99%) and specificity (98%) for detecting uterine fibroids 3

Saline infusion sonohysterography (SIS) enables better delineation between endometrial pathologies and submucosal fibroids, showing good agreement (kappa 0.80) with diagnostic hysteroscopy for classifying submucosal fibroids 4
MRI is superior to ultrasound for identifying and mapping fibroids, providing excellent delineation of fibroid location, size, number, and differentiating fibroids from adenomyosis and endometriosis 3, 4, 5

The American College of Radiology suggests an initial evaluation with pelvic ultrasound (combined TAUS and TVUS with Doppler) as first-line imaging, followed by saline infusion sonohysterography (SIS) for submucosal fibroids or endometrial cavity involvement, and MRI with and without contrast for complex cases 1, 3, 4

Inadequate assessment of submucosal fibroids that may affect fertility or cause abnormal uterine bleeding can be avoided with the use of SIS 4
Incomplete evaluation of the entire uterus, particularly in cases of multiple fibroids, can be addressed with the use of MRI 3
Relying solely on TVUS for large fibroids or an enlarged uterus without complementary TAUS can lead to misdiagnosis, highlighting the importance of combining imaging modalities 3