Assessment of Misplaced Intrauterine Contraceptive Devices by Different Imaging Modalities: A Cross-sectional Study

Abstract

Background: Radiology plays a vital role in the diagnosis of intrauterine contraceptive device (IUCD) migration. Ultrasound (US) is used for initial evaluation. It is inexpensive and widely available. The X-ray is required for the diagnosis of (IUCD) expulsion as all (IUCDs) are radiopaque and rarely computed tomography (CT) is used. Aim of the study: Evaluation of the role of different radiological modalities in the assessment of mal-positioned (IUCDs). Subjects and methods: A Cross-sectional study in the radiology department at Al Ahrar teaching hospital. Fifty patients were included with suspected misplaced (IUCD) over one year. Results: (US) was able to detect (IUCD) position in 88%, while in 12% (IUCD) could not be localized. X-ray was performed for 42 % and could confirm (US) result and exclude (IUCD) expulsion. (CT) was performed for 18% and could detect (IUCD) location when not seen in (US) and detect the associated complications. There was a significant agreement between the three diagnostic techniques and intraoperative findings. Conclusion: (US) is the first modality used in the diagnostic workup of the misplaced (IUCD), but it is not reliable if the omentum and bowel loops surround the device. The X-ray can help confirm (US) result and exclude expulsion. Rarely (CT) is used for (IUCD) localization. However, (CT) is the best for the evaluation of complications associated with intra-abdominal (IUCDs) and has a role in determining the proper method of removal.