Abstract
Purpose
Real-time virtual sonography (RVS) allows displaying and synchronizing real-time US and multiplanar reconstruction of MRI images. The purpose of this study was to evaluate the feasibility and ability of RVS to assess adenomyosis since literature shows US itself has a reduced diagnostic accuracy compared to MRI.
Materials and methods
This study was conducted over a 4-month period (March–June 2015). We enrolled in the study 52 women with clinical symptoms of dysmenorrhea, methrorragia and infertility. Every patient underwent an endovaginal US examination, followed by a 3T MRI exam and a RVS exam (Hitachi HI Vision Ascendus). The MRI image dataset acquired at the time of the examination was loaded into the fusion system and displayed together with the US images. Both sets of images were then manually synchronized and images were registered using multiple plane MR imaging. Radiologist was asked to report all three examinations separately.
Results
On a total of 52 patients, on standard endovaginal US, adenomyosis was detected in 27 cases: of these, 21 presented diffuse adenomyosis, and 6 cases focal form of adenomyosis. MRI detected adenomyosis in 30 cases: 22 of these appeared as diffuse form and 8 as focal form, such as adenomyoma and adenomyotic cyst, thus resulting in 3 misdiagnosed cases on US. RVS confirmed all 22 cases of diffuse adenomyosis and all 8 cases of focal adenomyosis.
Conclusions
Thanks to information from both US and MRI, fusion imaging allows better identification of adenomyosis and could improve the performance of ultrasound operator thus to implement the contribution of TVUS in daily practice.
Similar content being viewed by others
References
Kunz G, Beil D, Huppert P, Noe M, Kissler S, Leyendecker G (2005) Adenomyosis in endometriosis–prevalence and impact on fertility. Evidence from magnetic resonance imaging. Hum Reprod 20(8):2309–2316
Aziz R (1989) Adenomyosis: current perspectives. Obstet Gynecol Clin North Am 16(1):221–235
Kunz G, Herbertz M, Beil D, Huppert P, Leyendecker G (2007) Adenomyosis as a disorder of the early and late human reproductive period. Reprod Biomed Online 15(6):681–685
Bazot M, Cortez A, Darai E, Rouger J, Chopier J, Antoine JM et al (2001) Ultrasonography compared with magnetic resonance imaging for the diagnosis of adenomyosis: correlation with histopathology. Hum Reprod 16:2427–2433
Ascher SM, Arnold LL, Patt RH et al (1994) Adenomyosis: prospective comparison of MR imaging and transvaginal sonography. Radiology 190:803–806
Arnold LL, Ascher SM, Schruefer JJ et al (1995) The nonsurgical diagnosis of adenomyosis. Obstet Gynecol 86:461–465
Volkers NA, Hehenkamp WJ, Spijkerboer AM, Moolhuijzen AD, Birnie E, Ankum WM et al (2008) MR reproducibility in the assessment of uterine fibroids for patients scheduled for uterine artery embolization. Cardiovasc Interv Radiol 31:260–268
Fiori O, Darai E (2006) Adenomyosis in endometriosis–prevalence and impact on fertility. Evidence from magnetic resonance imaging. Hum Reprod 21(4):1101–1102 (author reply 1102-3)
Dueholm M (2006) Transvaginal ultrasound for diagnosis of adenomyosis: a review. Best Pract Res Clin Obstet Gynaecol 20:569–582
Reinhold C, McCarthy S, Bret PM, Mehio A, Atri M, Zakarian R et al (1996) Diffuse adenomyosis: comparison of endovaginal US and MR imaging with histopathologic correlation. Radiology 199:151–158
Exacoustos C, Brienza L, Di Giovanni A et al (2011) Adenomyosis: three-dimensional sonographic findings of the junctional zone and correlation with histology. Ultrasound Obstet Gynecol 37(4):471–479
Jung EM, Friedrich C, Hoffstetter P, Dendl LM, Klebl F, Agha A, Wiggermann P, Stroszcynski C, Schreyer AG (2012) Volume navigation with contrast enhanced ultrasound and image fusion for percutaneous interventions: first results. PLoS One 7(3):e33956
Abi-Jaoudeh N, Kruecker J, Kadoury S, Kobeiter H, Venkatesan AM, Levy E, Wood BJ (2012) Multimodality image fusion-guided procedures: technique, accuracy, and applications. Cardiovasc Interv Radiol 35:986–998
Lee JY, Choi BI, Chung YE, Kim MW, Kim SH (2012) Han JK Clinical value of CT/MR-ultrasound fusion imaging for radiofrequency ablation of hepatic nodules. Eur J Radiol 81:2281–2289
Millischer AE, Salomon LJ, Santulli P, Borghese B, Dousset B, Chapron C (2015) Fusion imaging for evaluation of deep infiltrating endometriosis: feasibility and preliminary results. Ultrasound Obstet Gynecol 46(1):109–117
Van den Bosch T, Dueholm M, Leone FP, Valentin L, Rasmussen CK, Votino A, Van Schoubroeck D, Landolfo C, Installé AJ, Guerriero S, Exacoustos C, Gordts S, Benacerraf B, D’Hooghe T, De Moor B, Brölmann H, Goldstein S, Epstein E, Bourne T, Timmerman D (2015) Terms, definitions and measurements to describe sonographic features ofmyometrium and uterine masses: a consensus opinion from the Morphological Uterus Sonographic Assessment (MUSA) group. Ultrasound Obstet Gynecol 46(3):284–298
Takeuchi Ml, Matsuzaki K (2011) Adenomyosis: usual and unusual imaging manifestations, pitfalls, and problem-solving MR imaging techniques. Radiographics 31(1):99–115
Maubon A, Faury A, Kapella M, Pouquet M, Piver P (2010) Uterine junctional zone at magnetic resonance imaging: a predictor of in vitro fertilization implantation failure. J Obstet Gynaecol Res 36(3):611–618
Fernando S, Breheny S, Jaques AM, Halliday JL, Baker G, Healy D (2009) Preterm birth, ovarian endometriomata, and assisted reproduction technologies. Fertil Steril 91(2):325–330
Lone FW, Balogun M, Khan KS (2006) Adenomyosis: not such an elusive diagnosis any longer. J Obstet Gynaecol 26(3):225–228 (review)
Champaneria R, Abedin P, Daniels J, Balogun M, Khan KS (2010) Ultrasound scan and magnetic resonance imaging for the diagnosis of adenomyosis: systematic review comparing test accuracy. Acta Obstet Gynecol Scand 89(11):1374–1384
Acknowledgements
We would like to thank Dr Luca Mastrogirolamo for his expertise which helped us in the successful comprehension of the RVS and its application.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The remaining authors declare that they have no conflict of interest.
Ethical standards
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Funding
Dr Lucia Manganaro has received a speaker honorarium from Hitachi Medical Systems S.p.A.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Rights and permissions
About this article
Cite this article
Vinci, V., Saldari, M., Sergi, M.E. et al. MRI, US or real-time virtual sonography in the evaluation of adenomyosis?. Radiol med 122, 361–368 (2017). https://doi.org/10.1007/s11547-017-0729-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11547-017-0729-7