1. Imaging of Intrauterine Contraceptive

Imaging of Intraute rine Contraceptive Devices Nagamani Peri, MD, David Graham, MD, Deborah Levine, MD Objective. Intrauterine contraceptive devices (IUDs) are reemerging as common methods of birth con- trol in the United States. Imaging, especially sonography, has an important role in their evaluation. This review illustrates the normal and abnormal imaging appearances of IUDs. Methods. We describe and illustrate the appearance of different types of IUDs on different imaging modalities as well as radio- logically relevant complications associated with IUDs. Results. On sonography, the IUD should be visualized as centrally located within the endometrial cavity, with the crossbar (if present) in the fundal portion of the endometrial cavity. Some older patients have IUDs in place that are no longer commonly used, such as the Lippes Loop (Ortho Pharmaceutical, Raritan, NJ) and Saf-T-Coil (Julius Schmid Laboratories, Little Falls, NJ), which have a pathognomonic appearance. Newer IUDs, such as the early version of the Mirena IUD (Leiras Oy, Turku, Finland), may be difficult to visualize on sonography. Patients from China frequently have a ring-shaped IUD. Sonography is important in assessing the complications of IUDs, including a low position, associated infection, myometrial migration, uterine perforation, intrauterine or extrauterine pregnancy associated with the IUD, and retention and frag- mentation of the IUD. If an IUD is known to be present but not visualized sonographically, plain radio- graphy is helpful in assessing the location. Computed tomography and magnetic resonance imaging are not typically used to assess IUDs, but the appearances of IUDs should be recognized with these modalities. Conclusions. Imaging, specifically sonography, has a crucial role in the evaluation and man- agement of IUDs and associated complications. Key words: contraceptive device; intrauterine contraceptive device, sonography. Received April 9, 2007, from the Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts USA. Revision requested Apr il 26, 200 7. Rev ised manuscript acc ept ed for pub lic ati on May 21, 2007 . Add ress cor resp ond ence to Deb ora h Lev ine , MD, Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 USA. E-mail: [email protected] u Abbreviations CT, computed tomography; IUD, intrauterine contraceptive device; MRI, magnetic resonance imaging; 3D, 3-dimensional ntrauterine contraceptive devices (IUDs) are the most wide ly use d rev ersi ble co ntr ace ptiv e meth ods wo rld- wide . 1 The history of IUDs dates back more than 3000 years, when smooth pebble s wer e inserte d into the uteruses of camels to prevent pregnancy during long trips in the desert. 2 In this article, we describe the imaging features of IUDs as they have evolved as well as the complications associated with IUDs from the imager’s perspective. Imaging has an important role in the evaluation of IUDs, not only to check that an IUD is in the correct position to be effective but also to assess for associated complications. Sonography (Figure 1) is the commonly used method to evaluate IUDs because it is easy to perform, is cost-effective, and lacks a risk of radiation. When an IUD is not found on a sonogram, a plain radiograph of the abdomen is helpful to determine its location (Figure 2). Computed tomography (CT) and magnetic resonance imaging (MRI) are not commonly used for assessment of © 2007 by the American Institute of Ultrasound in Medicine • J Ultrasound Med 2007; 26:1389–1401 • 0278-4297/07/$3.50 I Review Article

1. Imaging of Intrauterine Contraceptive

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