Dynamic Enhanced Mri in Diagnosing Adenomyosis by Graded Approach in Comparison With Hysteroscopy Biopsy Correlation

Abstract

BACKGROUND Adenomyosis is not an uncommon condition on routine ultrasonography. Specificity of ultrasound in adenomyosis is non-specific, probably due to inadequate bladder preparation and non-specific history background. In common, late stage adenomyosis is considerably diagnosed on ultrasound. Therefore, emphasis on importance of MRI in adenomyosis by standardised grading and early diagnostic algorithm is challenging in future prospects.The objective of this study is to diagnose different grades of adenomyosis from early to late changes and to compare MRI grading with grading by hysteroscopy biopsy. MATERIALS AND METHODSWe have decided the sample size of 49, calculated based on previous one year record in our hospital. Ultrasound was done (n= 49) and positive clinical background patients were included for MRI and further hysteroscopy biopsy. Hysteroscopy biopsy grading was done within 2 weeks follow-up and considered as Gold Standard. Based on grades of myometrial fibrous tissue involvement, results were compared. MRI reports were done by one experienced radiologist. RESULTSAll positive patients were studied and graded by MRI protocol. MRI graded approach shows better sensitivity for grades (Grades II and IV) as compared with (Grade I and III). The biopsy vs. MRI result showed that normal Grade I, Grade II, Grade III and Grade IV were 13.8% vs. 17.2%; 41.4% vs. 44.5; 31.0 vs. 31.0; 3.4 vs. 3.4 and 3.4 vs. 3.4 respectively. CONCLUSIONMRI graded approach algorithm as compared to routine MRI for adenomyosis proved to be a valid tool in future prospective; however, false positive results exist in higher grades.