A simple sonographic sign associated to the presence of adenomyosis (original) (raw)
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Fertility and Sterility, 2018
To study the interobserver reproducibility of our new ultrasonographic mapping system to define the type and extension of uterine adenomyosis. Design: Interobserver study involving two observers with different medical backgrounds and gynecological ultrasound experience. Setting: University hospital. Patients: Seventy consecutive women who underwent transvaginal ultrasound for suspected endometriosis, pelvic pain, heavy menstrual bleeding, and infertility. Intervention: Two operators (observers A and B), who were blinded, independently reviewed the ultrasound videos offline, assessing the type of adenomyosis and the severity of the disease. Diagnosis of adenomyosis was made when typical ultrasonographic features of the disease were observed at the examination. Adenomyosis was defined as diffuse, focal, and adenomyoma according to the ultrasonographic characteristics. The severity of adenomyosis was described using a new schematic scoring system that describes the extension of the disease considering all possible ultrasound adenomyosis features. Main Outcome Measures: Reproducibility of the new mapping system for adenomyosis and rate agreement between two operators. Results: Multiple rate agreements to classify the different features and the score of adenomyosis (diffuse, focal adenomyoma, and focal or diffuse alteration of junctional zone) ranged from substantial to almost perfect (Cohen k ¼ 0.658-1) except for adenomyoma score 4 (one or more adenomyomas with the largest diameter >40 mm) in which interobserver agreement was moderate (k ¼ 0.479). Conclusion: Our new scoring system for uterine adenomyosis is reproducible and could be useful in clinical practice. The standardization of the transvaginal approach and of the sonographer training represent a crucial point for a correct diagnosis of myometrial disease. (Fertil Steril Ò 2018;110:1154-61. Ó2018 by American Society for Reproductive Medicine.) El resumen está disponible en Español al final del artículo.
Morphological Uterus Sonographic Assessment Criteria for Adenomyosis Diagnostic: A Case Report
Open Access Macedonian Journal of Medical Sciences, 2022
BACKGROUND: The Morphological Uterus Sonographic Assessment (MUSA) statement is a consensus statement on terms, definitions, and measurements that may be used to describe and report the sonographic features of the myometrium using gray-scale sonography, color/power Doppler and three-dimensional ultrasound imaging. MUSA adenomyosis ultrasound features: Asymmetrical thickening, fan shape shadowing, cyst, hyperechoic island, echogenic sub endometrial lines and buds, trans lesion vascularity, irregular junctional zone, and interrupted junctional zone. Classification and descriptions of the MUSA criteria for adenomyosis are presented: Location, classification (diffuse/focal), cystic, layer involvement (type), extent, and size of the lesion. CASE REPORT: Mrs. D, 46 years old, P0A0, in this case, the patient was 46 years old with complaints of a history of heavy menstrual bleeding abnormal uterine bleeding, menstrual pain, and infertility. The vaginal toucher examination found uterus AF, size bigger than normal size, size of the baby's head, a little solid, mobile, smooth surface, tenderness (+), both adnexas: No mass (−), both parametrium laxed (+), and Douglas cavity not protruded. In the supporting examination with transabdominal sonography and transvaginal sonography, MUSA criteria were found: Hyperechoic appearance with indistinct borders with a size of 58 × 57.4 mm intrauterine, translesional vascularity, and disappear of endomyometrial junction. MUSA Description: Diffuse type 3, adenomyosis in the anterior and posterior wall, extent severe, and the biggest diameter is 7 cm. Diagnosed with adenomyosis, followed by surgical therapy (hysterectomy), because the patient did not need a reproductive function, and results of histopathology examination, concluded that it was adenomyosis. CONCLUSION: The MUSA criteria on how the sonographic features of adenomyosis should be described and measured, which should help improve diagnostic accuracy.
Transvaginal sonography in the diagnosis of adenomyosis: which findings are most accurate?
Ultrasound in Obstetrics and Gynecology, 2007
To evaluate the accuracy of various transvaginal sonographic findings in adenomyosis by comparing them with histopathological results and to determine the most valuable sonographic feature in the diagnosis of adenomyosis. In this prospective study, 70 consecutive patients scheduled for hysterectomy underwent preoperative transvaginal sonography. If at least one of the following sonographic features was present, a diagnosis of adenomyosis was made: heterogeneous myometrial echotexture, globular-appearing uterus, asymmetrical thickness of the anteroposterior wall of the myometrium, subendometrial myometrial cysts, subendometrial echogenic linear striations or poor definition of the endometrial-myometrial junction. The sonographic features were compared with the histopathological results. The prevalence of adenomyosis was 37.1% (26/70 patients). The sensitivity, specificity, positive (PPV) and negative (NPV) predictive values and accuracy of transvaginal ultrasound for the diagnosis of adenomyosis were 80.8%, 61.4%, 55.3%, 84.4% and 68.6%, respectively. We found that a regularly enlarged uterus with a globular appearance, subendometrial echogenic linear striations and myometrial cysts had the highest accuracy for the diagnosis of adenomyosis. Of all findings evaluated, heterogeneous myometrium was the most common in patients with adenomyosis (21/26 patients), but it had a poor specificity. The presence of subendometrial linear striations was the most specific sonographic feature (95.5%) and it had the highest PPV (80.0%) for the diagnosis of adenomyosis. The presence of subendometrial echogenic linear striations, a globular configuration and myometrial cysts on transvaginal ultrasound supports the diagnosis of adenomyosis. Among the transvaginal ultrasound diagnostic findings of adenomyosis, subendometrial linear striations have the highest diagnostic accuracy.
Ultrasound in Obstetrics & Gynecology, 2015
Objectives To investigate whether there are sonographic features of diffuse adenomyosis in 18-30-year-old nulligravid women without endometriosis and to examine their association with symptoms of dysmenorrhea and abnormal uterine bleeding. Methods This was a prospective observational study including women referred from a gynecology outpatient center to our university hospital for ultrasound examination. Inclusion criteria were age between 18 and 30 years, regular menstrual cycle and nulligravid status. Exclusion criteria were a past or current history of endometriosis, fibroids, ovarian cysts or lesions, endometrial pathology, current use of hormonal treatments or medications that would affect the menstrual cycle, previous uterine surgery and history of infertility. Women underwent a detailed clinical assessment and a two-(2D) and three-dimensional (3D) transvaginal ultrasound (TVS) examination. 2D-TVS features associated with diffuse adenomyosis were predefined as: (1) heterogeneous myometrium; (2) hypoechoic striation in the myometrium; (3) myometrial anechoic lacunae or cysts; (4) asymmetrical myometrial thickening of the uterine walls with the presence of straight vessels, extending into the hypertrophic myometrium, on power Doppler examination. On 3D-TVS, endomyometrial junctional zone (JZ) was measured as the distance from the basal endometrium to the internal layer of the outer myometrium on coronal section at any level of the uterus, and the smallest (JZmin) and largest (JZmax) JZ thicknesses and their difference (JZdiff) were recorded. 3D-TVS evaluation was considered suggestive for adenomyosis when JZmax
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2012
Journal of Personalized Medicine
Background: to compare several uterine biometric parameters at transvaginal ultrasound (TVUS) between adenomyosis and non-adenomyosis uteri and evaluate their role for the diagnosis of diffuse adenomyosis. Methods: prospective observational study conducted between the 1 February 2022 and the 30 April 2022. In this case, 56 patients with TVUS diagnosis of adenomyosis were included. A 1:1 ratio age and parity-matched group of non-adenomyosis patients was selected. We compared sonographic uterine biometric parameters (longitudinal (LD), anteroposterior (APD) and transverse (TD) diameters, volume, simple and complex diameter ratios) and investigated their diagnostic performance. Results: all sonographic parameters were significantly different between the study groups, except for TD/(LD+APD). Optimal cut-off values of APD and LD/APD showed the best sensitivity and specificity. APD diameter equal or superior to 39.5 mm (95% CI, 36.2–42.8) had sensitivity of 0.70 (95% CI, 0.57–0.80), speci...
Symptoms and classification of uterine adenomyosis, including the place of hysteroscopy in diagnosis
Fertility and Sterility, 2018
Where histology used the presence of glands and/or stroma in the myometrium as pathognomonic for adenomyosis, imaging uses the appearance of the myometrium, the presence of striations, related to the presence of endometrial tissue within the myometrium, the presence of intramyometrial cystic structures and the size and asymmetry of the uterus to identify adenomyosis. Preliminary reports show a good correlation between the features detected by imaging and the histological findings. Symptoms associated with adenomyosis are abnormal uterine bleeding, pelvic pain (dysmenorrhea, chronic pelvic pain, dyspareunia), and impaired reproduction. However a high incidence of existing comorbidity like fibroids and endometriosis makes it difficult to attribute a specific pathognomonic symptom to adenomyosis. Heterogeneity in the reported pregnancy rates after assisted reproduction is due to the use of different ovarian stimulation protocols and absence of a correct description of the adenomyotic pathology. Current efforts to classify the disease contributed a lot in elucidated the potential characteristics that a classification system should be relied on. The need for a comprehensive, user friendly, and clear categorization of adenomyosis including the pattern, location, histological variants, and the myometrial zone seems to be an urgent need. With the uterus as a possible unifying link between adenomyosis and endometriosis, exploration of the uterus should not only be restricted to the hysteroscopic exploration of the uterine cavity but in a fusion with ultrasound. (Fertil Steril Ò 2018;109:380-8. Ó2018 by American Society for Reproductive Medicine.