Ultrasound Diagnosis of Uterine Arteriovenous Malformations: A Systematic Review

Background: Uterine arteriovenous malformations (UAVM) are especially relevant vascular abnormalities due to the vital risk that may stem from severe genital bleeding. The objective of this systematic review was to evaluate the ultrasound criteria for the diagnosis of UAVM and determine which ones are the consistently relevant for the diagnosis of UAVM. Methods: For this systemic review, we followed PRISMA 2020 guidelines. The systematic search was carried out in PubMed and Embase databases up to January 31st, 2023. The total amount of articles compiled with the search strategy was 3191. Results: 21 records met the inclusion criteria and were included in the review. The results revealed the heterogeneity in the studies on UAVM, as not all studies use the same ultrasound (US) features. Most of the included articles described data on US findings in the grayscale mode, which were variable and not specific for the diagnosis. In terms of color Doppler mapping and spectral Doppler analysis, the findings were consistent in all articles included, showing abnormal strong hypervascular lesions corresponding with a tangle of irregular vessels with multidirectional and strongly turbulent intraluminal flow. Conclusions: Ultrasound diagnosis of uterine arteriovenous malformations might be initially suspected in the grayscale mode, although the color and spectral Doppler assessment seems to be the key to achieving a consistent diagnosis with the visualization of a tangle of vessels in a ‘mosaic’ pattern with multidirectional turbulent flow in an arteriovenous shunting, with high-velocity and low-impedance values in spectral flow analysis.