Reliable diagnosis of adenomyosis and uterine fibroids using transvaginal ultrasonography with strain elastography

Abstract

Introduction: Special types of benign gynecological conditions such as uterine fibroids and adenomyosis are very common these days. So our main objective is to assess the diagnostic accuracy of transvaginal ultrasonography combined with strain-ratio elastography (SRE) in diagnosing Adenomyosis and Uterine Fibroids and to compare the results with magnetic resonance imaging (MRI)-based diagnoses. Material and Methods: In a prospective study was conducted on 84 women with suspected adenomyosis or fibroid on transabdomisnal sonography. These patients underwent transvaginal ultrasonography combined with strain-ratio elastography. This was followed by MRI imaging of the same patients. Computation of strain values at two ROIs placed next toeach other in a uterine adenomyosis or fibroid (ROI A) and the normal myometrium (ROI B). The strain ratio (B/A) was calculated and stored. These elastography based diagnoses were compared with MRI diagnoses. Results: The myometrium was uniform in color, with a main color of green, indicating stiffer tissue. Adenomyosis and fibroids had dissimilar attributes with respect to elastographic and color patterns. In general, fibroids were darker blue and adenomyosis was yellowish to red in color. The median strain ratio was significantly (p<0.001) different between the uterine fibroid and adenomyosis. Median strain ratio were 1.85 and 0.54 for fibroids and adenomyosis respectively. The diagnosis of adenomyosis and fibroids using elastography shows harmonious results with MRI-based diagnosis. Conclusions: The chromic data makes it possible for detecting uterine fibroid and adenomyosis and assists to detect both focal findings, in addition, the strain ratio allows for quantification of the stiffness factor. The quantitative data from the strain ratio is more useful than the qualitative color-coded images. Elastography is capable of recognizing discerning attributes of fibroids and adenomyosis. Elastography based conclusions are in excellent agreement with that of MRI. With easier and cheaper availability of the sonographic setup and reduced scanning time as compared to MRI, transvaginal ultrasonography in conjugation with strain ratio can be used to make a reliable diagnosis of fibroid or adenomyosis.