Imaging of the Uterus after Endometrial Ablation

Endometrial ablation (EA), a therapeutic alternative to hysterectomy for the treatment of excessive uterine bleeding, is increasing in utilization and popularity among gynecologists performing this procedure and women undergoing it. The increase in utilization of this minimally invasive surgery has resulted in the growth of intentional and nonintentional imaging of the postablation uterus. Although routinely performed cross-sectional imaging modalities such as US, CT, and MRI are expected to provide optimal assessment of the post-EA uterus, often the findings are confusing as they overlap with those of other pathologic processes seen in the uterus such as endometrial cancer and adenomyosis, resulting in misinterpretation. In addition, many radiologists are unaware of the changes in the uterus after the procedure. Moreover, many women undergo imaging for unrelated medical conditions, and this pertinent surgical history may be unknown or undocumented at the time of imaging review, making radiologic interpretations even more challenging. The radiologic literature is scarce on this topic, with few articles describing imaging findings of the postablation uterus. This striking gap in knowledge leads to a wide range of misdiagnoses and mismanagement. The authors provide a brief summary of the pathophysiology of abnormal uterine bleeding and discuss the main concepts of EA techniques, followed by a focused detailed description of the imaging findings associated with EA, which can aid in recognition of the expected changes in the uterus, as well as accurate identification, diagnosis, and prompt management of related complications. Additionally, the authors provide a review of differentiating features that can help with diagnosis of other pathologic conditions of the uterus that can mimic post-EA related changes. ©RSNA, 2025 Supplemental material is available for this article.