Can uterine fibroids be visualized on computed tomography (CT) imaging in a female patient of reproductive age?

Can Uterine Fibroids Be Seen on CT Imaging?

Yes, uterine fibroids can be visualized on CT imaging, particularly with contrast enhancement, though CT is not the preferred modality for routine fibroid evaluation. 1

Role of CT in Fibroid Imaging

CT has no direct role in routine surveillance or initial evaluation of uterine fibroids but serves specific clinical purposes: 1

When CT Is Useful for Fibroids

• Contrast-enhanced CT is helpful for identifying fibroids that have undergone torsion or necrosis, with diminished contrast enhancement of the fibroid demonstrating 86% sensitivity and ascites showing 100% sensitivity for these complications. 1

• CT is particularly useful when calcified fibroids cause acoustic shadowing that limits ultrasound visualization of pelvic contents. 1

• CT with IV contrast is the appropriate modality following uterine fibroid embolization (UFE) when patients present with pelvic pain or fever to evaluate for acute complications including infection (endometritis, pyometra, pyomyoma), hemorrhage, or pelvic venous thrombosis. 1

Preferred Imaging Modalities

First-Line Imaging

• Combined transvaginal and transabdominal ultrasound is the first-line imaging modality for fibroid evaluation, with transvaginal ultrasound achieving 90-99% sensitivity for detecting fibroids and 90% sensitivity with 98% specificity for submucosal fibroids specifically. 1, 2

• Color Doppler should be performed as a standard component of pelvic ultrasound to evaluate fibroid vascularity and differentiate fibroids from other pathology. 1, 3

Problem-Solving Imaging

• MRI with gadolinium-based contrast is superior to both ultrasound and CT for identifying and mapping fibroids, altering management in up to 28% of patients by providing detailed information on location, volume, number, signal characteristics, and enhancement patterns. 1, 2

• MRI is the preferred modality when ultrasound findings are equivocal or when detailed characterization is needed for treatment planning, particularly before uterine fibroid embolization or focused ultrasound procedures. 1, 3, 2

Clinical Algorithm for Fibroid Imaging

1. Start with combined transvaginal and transabdominal ultrasound with Doppler for initial evaluation of suspected fibroids. 1, 2

2. Proceed to MRI with contrast if ultrasound is limited by patient body habitus, multiple fibroids obscure visualization, or detailed mapping is needed for surgical/interventional planning. 1, 2

3. Reserve CT for specific scenarios: calcified fibroids limiting ultrasound, post-UFE complications, or when CT is performed for other indications and incidentally detects fibroids. 1

Important Caveats

• CT exposes patients to ionizing radiation without providing the soft-tissue detail of MRI or the cost-effectiveness and accessibility of ultrasound, making it a poor choice for routine fibroid evaluation. 1

• Fibroids discovered incidentally on CT performed for other reasons should prompt dedicated pelvic ultrasound if the patient has symptoms or if further characterization would change management. 4, 5

• Post-UFE complications occur in 1.25% of patients overall, with infection rates up to 2%, making contrast-enhanced CT appropriate when these complications are suspected clinically. 1