Transvaginal Elastosonography as an Imaging Technique for Diagnosing Adenomyosis

Abstract

To test the hypothesis that the lesional stiffness as measured by transvaginal elastosonography (TVESG) correlates with the extent of fibrosis in adenomyotic (AM) lesions, and thus TVESG can be used to diagnose AM, we conducted 2 studies. The first evaluated the relationship, if any, between lesional stiffness and lesional histology in 35 women with histologically confirmed AM in comparison with tissue stiffness in 11 control myometrial (CM) and 8 uterine fibroids (UFs) tissue samples. The second validated the relationship between lesional stiffness and the severity of dysmenorrhea and the amount of menses in AM patients by recruiting 112 patients diagnosed with AM, 67 with UF, and 130 controls. Transvaginal ultrasound and TVESG were both performed. We found that the stiffness of AM lesions was significantly higher than that of UF, which, in turn, was significantly higher than that of CM. Lesional stiffness correlated positively with uterine size and the extent of lesional fibrosis but negatively with E-cadherin and progesterone receptor expression levels. Lesional stiffness also correlated with the severity of dysmenorrhea as well as the amount of menses. Thus, TVESG can improve the diagnostic accuracy for AM, especially in differential diagnosis of AM from UF. The correlation between lesional stiffness and the extent of fibrosis and hormonal receptor expression and the severity of symptomology strongly suggests that TVESG not only can provide an instant assessment of the developmental stage of AM lesions but also may be used to guide the choice of the best treatment modality for the patient.

The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years: 2018 revisions

“…) or, if available, using MRI . Although promising for the diagnosis of adenomyosis, the role of both three‐dimensional TVUS and sonographic elastography is still a subject of investigation.…”

Value of Strain-Ratio Elastography in the Diagnosis and Differentiation of Uterine Fibroids and Adenomyosis

“…Adenomyosis and uterine fibroids represent two benign distinct uterine disorders, with an important frequency among young women [ 1 ]. Adenomyosis (AM) is defined by abnormal migration of endometrial tissue into the myometrium and causes myometrial inflammation and hypertrophy [ 2 , 3 ]. Its finding among uterine specimens obtained after hysterectomy vary between 5 and 70%, and the prevalence of this pathology among the general population is considered to be 28.9 in 10,000 women [ 2 , 4 ].…”

Ultrasound Shear Wave Velocity Varies Across Anatomical Region in Ex Vivo Bovine Ovaries

“…Furthermore, we anticipate that SW ultrasound elastography will be used increasingly as part of the standard work-up for infertility and fertility preservation counseling since ovarian tissue stiffness has been an implication in oocyte quality. 21 SW ultrasound elastography has also been applied to other nonovarian gynecologic pathologies, such as adenomyosis, [71][72][73][74] fibroids, 72,74 endometrial cancer, 75 cervical cancer, 76,77 pelvic floor disorders, 78,79 cervical insufficiency, [80][81][82] and preterm delivery. 83 Simultaneous advances in our understanding and interpretation of SW ultrasound elastography from basic science and engineering to clinical medicine are expected to contribute to our understanding of and ability to model tissue structure and function in health and disease and to improve patient care, by improving diagnosis and prognosis in a noninvasive way.…”