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

Abstract

Benign uterine disorders, including uterine fibroids (UF) and adenomyosis (AM), can impact the life quality and fertility of women of reproductive age. Transvaginal ultrasound (TVUS) has long been used for their early identification, but its combined use with elastography seems to improve diagnostic accuracy of UF and AM. Thus, a prospective pilot study was conducted on 79 patients who underwent hysterectomy (25 microscopically diagnosed with AM and 53 with UF), with the aim of assessing the ability of TVUS combined with strain ratio elastography (SE) to accurately diagnose and distinguish UF and AM. Significantly higher mean and maximal strain ratio (SR) values were identified for patients with histologically confirmed AM as opposed to those with UF (p < 0.001). Diagnostic sensitivity and specificity, calculated in comparison with histology results, were higher for UF than AM. Receiver operating characteristic (ROC) analysis was applied between the two study groups, revealing cutoff values of 7.71 for mean SR and 8.91 for maximal SR, respectively, with good sensitivity and specificity parameters (100% and 96.23%; 96% and 96.23%). Our results support the use of TVUS in combination with SE for the positive and differential diagnosis of UF and AM, through identification of their particular tissue stiffness features.

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

“…In our study, min and max SR values were obtained, with adenomyotic tissue being the stiffest, followed by fibromatous tissue and normal myometrium, these results being similar to the ones depicted by Liu et al and within one of our previous studies, conducted on patients with AM or UF [16,18]. Still, Liu et al reported lower numerical values, which may be explained by the differences between the manufacturers of the ultrasonography devices used [30].…”

“…According to literature data, SRE might be a valuable tool in the diagnosis of adenomyosis, but the appliance of SWE revealed contradictory results [9,18,19,33]. On the other hand, in the differential diagnosis of concomitantly existent uterine fibroids and adenomyosis, only SRE has proven its effectiveness so far [9,16,18].…”

“…Although, in the case of uterine fibromatosis, the TVUS diagnosis can be easily reached, regardless of the examiner, an accurate ultrasound diagnosis of adenomyosis is highly dependent on the subjective perception of the examiner and his/her experience [31,34,35]. Hence, the combined diagnosis of these pathologies is mostly operator-dependent, and once the suspicion is raised by TVUS, elastography can provide an advantage in establishing the presence or absence of concomitant lesions of AM and UF [16,30,34]. The subjective perception of the examiner might have also influenced the inaccurate diagnosis of 4 patients included in our study, in which only one of the two pathologies was suspected.…”

“…Transvaginal ultrasound (TVUS) is currently a first-line diagnostic tool because it is generally available, well-tolerated, cheap and relatively accurate when properly used [7][8][9]. MUSA (Morphological Uterus Sonographic Assessment) group created a universal reporting system of 2D TVUS ultrasound patterns for AM and UF, which aimed to improve diagnostic algorithms and reduce interobserver variability [11,15,16]. These features consist of uterine corpus evaluation (echogenicity and symmetry), detection of lesions of the myometrium and endometrium, as well as their patterns (location, size, number and shadowing) and assessment of Doppler color score of the myometrium (graded from 1 representing no color or minimal color, up to 4, which represents abundant color) [15].…”

Adenomyosis and fertility: does adenomyosis impact fertility and does treatment improve outcomes

“…3D TVUS can help evaluate the junctional zone and increase diagnostic accuracy [15,16 ▪ ,17 ▪ ]. Elastography has been proposed to help differentiate between fibroids and adenomyosis, with mixed results [16 ▪ ,18 ▪ ]. The results of recent studies investigating accuracy of different TVUS criteria are summarized in Table 1.…”