When Gynecologic Imaging Is Needed — and What Each Modality Shows
Not every gynecologic symptom requires imaging — and not every type of imaging is appropriate for every symptom. Understanding when imaging adds clinical value, which modality provides the most useful information, and what imaging cannot tell you is part of the informed decision-making process at Lapeer Women’s Health.
Dr. Andrei orders gynecologic imaging when the findings will change clinical management — when imaging results will determine whether a procedure is needed, which treatment to pursue, or whether watchful waiting is appropriate. Imaging ordered reflexively, without a clear clinical question it is expected to answer, adds cost, radiation exposure in the case of CT, and patient anxiety without improving care.
This page explains the four main imaging modalities used in gynecology, what each is best suited to evaluate, and the clinical scenarios in which Dr. Andrei orders each one. It is intended as an educational resource — the decision about which imaging is appropriate for your situation is made at your clinical appointment.
Four Types of Gynecologic Imaging — What Each Does
Each imaging modality has specific strengths and limitations. Dr. Andrei selects the most appropriate tool for the clinical question being asked.
Transvaginal ultrasound (TVUS)
The first-line imaging study for most gynecologic symptoms. High resolution, no radiation, real-time imaging of the uterus and ovaries. Best for: fibroids, ovarian cysts, endometrial thickness measurement, polyp detection, follicle counting, and early structural evaluation. Performed in-office at both LWH locations.
Transabdominal ultrasound
Complements TVUS for evaluating larger uteri, fibroids extending above the pelvis, or when a broader field of view is needed. Requires a full bladder. Usually performed together with TVUS rather than as a standalone study.
Sonohysterogram — saline infusion sonography (SIS)
Saline is instilled into the uterine cavity during transvaginal ultrasound to improve visualization of the endometrial lining and intrauterine structures. Best for: confirming polyps suspected on standard ultrasound, evaluating the uterine cavity before IVF, and characterizing submucosal fibroids. More informative than standard TVUS for intrauterine pathology, less invasive than hysteroscopy.
Pelvic MRI
Provides superior soft tissue detail for complex cases where ultrasound is insufficient. Best for: adenomyosis characterization, complex adnexal mass evaluation, deep infiltrating endometriosis mapping, fibroid mapping before myomectomy, and surgical planning. No radiation. Ordered when ultrasound findings are inconclusive or when surgical planning requires precise anatomical detail.
CT of the abdomen and pelvis
Used when an acute abdominal or pelvic process requires rapid comprehensive evaluation — or when a pelvic mass requires characterization beyond what ultrasound provides. Involves ionizing radiation. In gynecology, CT is most commonly ordered for evaluation of acute pain with concern for appendicitis, bowel pathology, or large complex masses. Not the first-line tool for routine gynecologic evaluation.
When no imaging is needed
A normal pelvic exam with a clear clinical diagnosis often does not require imaging before initiating treatment. Uncomplicated dysmenorrhea, straightforward contraception management, and STI treatment do not routinely require ultrasound. Dr. Andrei discusses whether imaging is indicated at your visit and explains the reasoning.
How Dr. Andrei Decides When to Order Imaging
The decision to order imaging follows a consistent clinical framework at Lapeer Women’s Health. The clinical question drives the modality selection — not habit or protocol.
- Abnormal uterine bleeding — transvaginal ultrasound first to measure endometrial stripe and identify structural causes
- Suspected fibroid — TVUS to confirm, characterize location, and measure size; MRI for surgical planning when multiple or complex
- Suspected ovarian cyst — TVUS to characterize morphology; follow-up TVUS in 6–12 weeks for simple cysts; MRI or referral for complex masses
- Suspected polyp on standard TVUS — sonohysterogram for confirmation before proceeding to hysteroscopy
- Suspected adenomyosis — TVUS shows uterine heterogeneity; MRI confirms when TVUS findings are equivocal
- Acute pelvic pain — TVUS first; CT added when bowel or appendiceal pathology must be excluded
“Imaging is one of the most powerful tools in gynecology — when it is ordered for the right reason. I want patients to understand what the imaging is for, what it can show, and what the result means for their care. That conversation should happen before the order is placed.”
- All imaging ordered at LWH is accompanied by an explanation of what is being evaluated and why
- In-office TVUS results reviewed with you at the same appointment
- External imaging results (MRI, CT) reviewed by Dr. Andrei and discussed at a follow-up visit or by phone
- Imaging findings that require additional workup are explained in plain language — not left for patients to interpret from a portal report
- When imaging is normal and symptoms persist, Dr. Andrei discusses what the normal result means and what the next diagnostic step should be
Common Questions About Gynecologic Imaging
The Right Imaging.
For the Right Reason.
If you have been told you need gynecologic imaging, or if symptoms suggest an evaluation is warranted, Dr. Andrei will determine the most appropriate diagnostic approach at your appointment — in-office ultrasound available at both Lapeer and Rochester Hills.
The information on this page is intended for educational purposes only and does not constitute medical advice. Individual symptoms, diagnoses, and treatment options vary significantly. Reading this content does not establish a physician-patient relationship with Dr. Ramona D. Andrei or Lapeer Women’s Health. If you are experiencing a medical emergency, call 911 or go to the nearest emergency room immediately. Please consult a qualified healthcare provider for advice specific to your situation. Content reviewed by Dr. Ramona D. Andrei, MD PhD FACOG.
Gynecologic care for women of every age
Lapeer Women’s Health — Rochester Hills
2710 S Rochester Rd, Suite 2
Rochester Hills, MI 48307
Serving patients in Lapeer, Rochester Hills, and surrounding communities throughout Southeast Michigan.