Uterine Fibroids Diagnosis and Tests

• Transvaginal Ultrasonography (TVUS): This is the gold standard first-line imaging modality. It uses high-frequency sound waves to visualize the pelvic organs. TVUS is highly sensitive (95-100%) for detecting fibroids. It allows the sonographer to measure the uterus’s dimensions, assess endometrial thickness, and map fibroid locations. Color Doppler is used to evaluate tumor vascularity (circumferential flow) and distinguish it from adenomyosis (diffuse flow) or ovarian masses.
• Saline Infusion Sonohysterography (SIS): Standard ultrasound can sometimes miss small submucosal fibroids or confuse them with polyps. SIS involves injecting sterile saline into the uterine cavity via a small catheter during the ultrasound. The saline distends the cavity, providing an anechoic (black) background that creates sharp contrast. This allows for the precise diagnosis of Type 0, 1, and 2 submucosal fibroids and assessment of their intracavitary extension, which is vital for planning hysteroscopic surgery.
• Magnetic Resonance Imaging (MRI): MRI is the most accurate imaging technique for mapping fibroids and is utilized for complex cases at Liv Hospital.
  • Differentiation: It provides superior soft-tissue contrast, allowing definitive differentiation between leiomyomas, adenomyosis (a common mimic that requires different treatment), and leiomyosarcomas.
  • Surgical Planning: It is mandatory before fertility-sparing surgeries (myomectomy) to ensure no fibroids are missed and before Uterine Artery Embolization (UAE) to assess the blood supply.
  • Protocol: T2-weighted images typically show fibroids as well-circumscribed, hypointense (dark) masses compared to the myometrium. Degenerated fibroids may show variable signal intensity.
• Computed Tomography (CT): CT is generally not the modality of choice for pelvic pathology due to its inferior soft-tissue contrast compared with MRI. However, fibroids are often incidental findings on CT scans performed for other reasons (e.g., abdominal pain).

Hysteroscopy: This is a diagnostic (and potentially therapeutic) procedure where a thin telescope (hysteroscope) is inserted through the cervix into the uterus. It allows for direct visual inspection of the endometrial cavity. It is the gold standard for diagnosing submucosal fibroids and assessing the feasibility of transcervical resection.