Transvaginal Ultrasound Combined with Strain-Ratio Elastography for the Concomitant Diagnosis of Uterine Fibroids and Adenomyosis: A Pilot Study

Abstract

Uterine fibroids (UFs) and adenomyosis (AM) represent two benign uterine conditions that can affect fertility and are most frequently commonly responsible for abnormal uterine bleeding and chronic pelvic pain. Their differential diagnosis still represents a challenge, and several authors advise the addition of elastography to transvaginal ultrasound (TVUS) for a more accurate imagistic recognition. Through this study, we aimed to assess the diagnostic accuracy of TVUS combined with strain-ratio elastography (SRE) in concomitant AM and UFs. We conducted a study on 17 patients diagnosed with concomitant UFs and AM undergoing hysterectomy and 46 healthy patients. TVUS combined with SRE was conducted in each patient, focusing on identifying rigidity patterns of the lesions. Significantly higher mean SR and maximum SR values were identified among both AM and UF lesions as opposed to controls (p < 0.01), with the highest tissue stiffness being encountered among AM lesions, which allows for the differentiation of UF (p < 0.01) and concomitant identification of both lesions. These results are reflected by higher cut-off values obtained for AM, both for mean SR (5.42 vs. 2.85) and maximum SR (5.80 vs. 3.30). TVUS combined with SRE showed good diagnostic performance in identifying coexisting UFs and AM within the same uterine specimen. Future studies on wider populations are required to validate our findings.

Feasibility and Safety of Transvaginal Natural Orifice Transluminal Endoscopic Surgery (V-NOTES) Panhysterectomy: A Polycentric Retrospective Study

“…Patients who underwent panhysterectomy due to hysteromyoma were selected for the study. As hysteromyoma is a common clinical disease, its prevalence rate is on the rise and tends to be found among younger patients [13,14] , making it easier for clinical data collection. The existing hysteromyoma treatment options include drug therapy and surgical therapy, and surgery is the most effective and direct mode of treatment.…”

Application of elastography to diagnose adenomyosis and evaluate the degree of dysmenorrhea: a prospective observational study

“…Elastography, an imaging tool to evaluate tissue stiffness, can be used to measure lesion stiffness and assess the progression of adenomyosis [ 6 , 15 , 16 ]. Elastography has been shown to improve the sensitivity and specificity of the ultrasound diagnosis of adenomyosis and has great value in the differential diagnosis of adenomyosis and uterine fibroids [ 6 , 16 – 18 ]. The stiffness of adenomyotic lesions is higher than that of uterine fibroids, both of which are higher than that of normal myometrium; these results are consistent with our findings.…”