Objective To analyze the significance of Transvaginal color Doppler ultrasound (TVCDU) blood flow imaging in the diagnosis of uterine fibroids. Methods 106 patients with suspected uterine fibroids admitted to our hospital from January 2022 to December 2023 were selected as the study objects. All patients underwent TVCDU blood flow imaging and Transabdominal color Doppler ultrasound (TVCDS) respectively. With puncture pathology as the "gold standard" for the diagnosis of uterine fibroids, the diagnostic results and diagnostic efficacy of TVCDU blood flow imaging and TVCDS were analyzed. Results Among 106 suspected patients with uterine fibroids, 39 cases were positive and 67 cases were negative. TVCDU blood flow imaging showed true positive and true negative in 38 cases and 66 cases, respectively. The true positive and true negative results of TVCDS were 31 and 58 cases respectively. The diagnostic sensitivity, specificity and accuracy of TVCDU blood flow imaging were 97.44% (38/39), 98.51% (66/67) and 98.11% (104/106), which were significantly higher than those of TVCDS, 79.49% (31/39), 86.57% (58/67) and 83.96% (89/106). The missed diagnosis rate of 2.56% (1/39) and misdiagnosis rate of 1.49% (1/67) were significantly lower than those diagnosed by TVCDS (20.51% (8/39) and 13.43% (9/67) (P < 0.05). The positive predictive value of TVCDU was 97.44% (38/39) and the negative predictive value of TVCDU was 98.51% (66/67) compared with 77.50% (31/40) and 87.88% (58/64) of TVCDS (P < 0.05). Conclusion The application of TVCDU blood flow imaging in the diagnosis of uterine fibroids can significantly improve the diagnostic sensitivity and accuracy, reduce the occurrence of missed diagnosis and misdiagnosis events, and the predictive value is good.