From the Guidelines
For a postmenopausal patient with bladder pressure and ovaries not visualized on ultrasound, MRI without IV contrast is the best initial imaging modality to evaluate the ovaries and bladder, as it provides excellent soft tissue resolution and can help identify potential causes of symptoms without the need for contrast. This recommendation is based on the most recent and highest quality study available, which suggests that MRI without IV contrast can be useful in evaluating the ovaries, especially when they are not adequately visualized with ultrasound 1. The use of MRI without IV contrast is particularly valuable in postmenopausal women, where ovarian visualization can be challenging due to atrophy and reduced size, and where distinguishing between benign conditions and early malignancies is crucial for appropriate management. Some key points to consider when evaluating the ovaries and bladder in a postmenopausal patient include:
- The importance of using a non-invasive and non-ionizing imaging modality, such as MRI, to minimize risks to the patient
- The need to evaluate the ovaries and bladder comprehensively, using a multiplanar imaging approach to detect small lesions and abnormalities
- The potential benefits of using MRI without IV contrast, which can help reduce costs and minimize the risk of adverse reactions to contrast agents
- The importance of considering the patient's symptoms and medical history when selecting an imaging modality, and choosing the modality that is most likely to provide useful diagnostic information. It's worth noting that while CT is an alternative, it delivers radiation and provides less detailed soft tissue contrast, making MRI a better choice for evaluating the ovaries and bladder in postmenopausal women 1. Additionally, the American College of Radiology Appropriateness Criteria suggest that MRI without IV contrast can be used to evaluate the ovaries and bladder in postmenopausal women, particularly when the ovaries are not adequately visualized with ultrasound 1.
From the Research
Imaging Modalities for Evaluating Ovaries and Bladder
- The best imaging modality to evaluate the ovaries and bladder in a postmenopausal patient with bladder pressure and ovaries not seen on ultrasound is not explicitly stated in the provided studies.
- However, based on the studies, transvaginal ultrasonography is a commonly used modality for evaluating the ovaries in postmenopausal women 2, 3, 4.
- The studies suggest that transvaginal ultrasonography can be used to identify ovarian lesions and assess ovarian morphology, but its effectiveness may be limited by factors such as age, body mass index, and previous pelvic surgery 3.
- Other imaging modalities, such as color and power Doppler examination and three-dimensional ultrasound, may also be useful in evaluating the ovaries and detecting ovarian lesions 5.
- For evaluating the bladder, the studies do not provide specific recommendations, but ultrasound is a common imaging modality used to assess the bladder and urinary tract.
Factors Affecting Ovarian Visualization
- Several factors can affect the visualization of postmenopausal ovaries, including:
- Age: increasing age can decrease ovarian visualization 3
- Body mass index: being overweight or obese can decrease ovarian visualization 3
- Previous pelvic surgery: previous hysterectomy or tubal ligation can decrease ovarian visualization 3
- Lifestyle and reproductive factors: a history of infertility can increase ovarian visualization 3
Ultrasound Morphology of the Uterus and Ovaries
- The ultrasound morphology of the uterus and ovaries changes during the menopausal transition and early postmenopause, with decreases in uterine and ovarian size and changes in ovarian morphology 4.
- The number of intraovarian follicle-like cystic structures also changes during this period, with a decrease in the number of follicles after menopause 4.