What is the recommended diagnostic test of choice for suspected uterine leiomyomas?

The recommended diagnostic test of choice for suspected uterine leiomyomas, or fibroids, is transvaginal ultrasound. This imaging technique is preferred due to its ability to provide high-resolution images of the uterus and surrounding structures. Transvaginal ultrasound offers several advantages in the assessment of uterine leiomyomas, including greater sensitivity in detecting small fibroids and the ability to visualize the posterior aspect of the uterus more clearly compared to transabdominal ultrasound.

Transvaginal ultrasound allows for close proximity to the pelvic organs, which enhances the detail and accuracy of the imaging. It is a non-invasive, widely available, and cost-effective method that can be performed in an outpatient setting. The procedure is also associated with minimal discomfort for the patient, making it a practical option for initial evaluation.

While MRI is highly sensitive and can provide extensive information about uterine fibroids, it is typically reserved for complex cases where there is uncertainty in diagnosis or when planning surgical intervention. CT scans are generally not utilized for imaging uterine fibroids due to the exposure to radiation and inferior visualization of soft tissue compared to ultrasound or MRI. Therefore, transvaginal ultrasound stands out as the first-line diagnostic test for suspected uterine leiomyomas.