Using B-Mode Ultrasonography, Doppler, and Strain-Wave Elastography in differentiating Submucosal Fibroid and Intrauterine Polyps

Abnormal uterine bleeding is a commonly encountered entity in pre-menopausal and post-menopausal women, with endometrial polyps and submucosal fibroids being common etiologies. The first-line imaging examination in the diagnosis of endometrial polyps as well as submucosal fibroids is ultrasound, but its accuracy is not apparent. Elastography is an ultrasound-based imaging modality used to assess the stiffness of examined tissues. Because endometrial polyps derive from soft endometrial tissue and submucosal fibroids are made of hard muscle tissue, elastography seems a promising tool to differentiate between such lesions. We aim to assess whether strain elastography may be used to visualise the difference in stiffness of endometrial polyps and submucosal fibroids. This was followed up on the pathological results post-operatively. It was demonstrated in this study that strain-wave elastography makes assessing the stiffness of intrauterine lesions possible, which may help differentiate between endometrial polyps and submucosal fibroids. However, other ancillary findings like vascularity in Doppler imaging and echogenicity in B mode ultrasound can greatly help distinguish between the two entities. Combining all these modalities will help us achieve greater diagnostic confidence in differentiating submucosal fibroids from intrauterine polyps, as concluded by this study.