Abstract
Purpose
MRI is the current imaging gold standard to diagnose adenomyosis, but access is often limited by high costs and availability. Transvaginal ultrasound provides a cost-effective, accurate and readily available alternative. The objective of our study was to determine the diagnostic accuracy of commonly described sonographic findings in predicting uterine adenomyosis.
Methods
This retrospective study evaluated 649 MRI studies performed to investigate adenomyosis with a preceding transvaginal ultrasound within 12 months between 2013 and 2018. Two blinded reviewers assessed the presence or absence of six sonographic features: bulky uterus, heterogeneous myometrium, streaky myometrium, myometrial cysts, endometrial–myometrial interface ill-definition, and echogenic linear striations. The sensitivity, specificity, positive and negative predictive values of these features were calculated individually and in combination when compared to MRI as the standard of reference.
Results
Adenomyosis was found in 315 (48.5%) cases on MRI. Ultrasound had a high specificity of 91.8% (95% CI 88.4 to 94.6%) but was less sensitive (36.8% (95% CI 31.5 to 42.4%)) for detecting adenomyosis. Comorbid fibroids or focal adenomyosis did not affect diagnostic accuracy. All six variables were significantly more common in patients with adenomyosis compared to those without. Individually, ‘bulky uterus’ and ‘heterogenous myometrium’ each demonstrated a mean sensitivity and specificity > 50%. The best dual combined variables were ‘bulky uterus’ + ‘ill definition of the endometrial–myometrial interface’ (sensitivity 39%, specificity 91%). The best triple combined variables were ‘bulky uterus’, ‘heterogeneous myometrium’ + ‘ill definition of the endometrial-myometrial interface’ (sensitivity 38%, specificity 93%).
Conclusion
Transvaginal ultrasound is highly specific for diagnosing uterine adenomyosis, providing a cost-effective and readily available alternative to MRI.
Similar content being viewed by others
References
Reinhold C, Tafazoli F, Mehio A, Wang L, Atri M, Siegelman ES, Rohoman L (1999) Uterine adenomyosis: endovaginal US and MR imaging features with histopathologic correlation. Radiographics: a review publication of the Radiological Society of North America, Inc 19 Spec No:S147-160. https://doi.org/10.1148/radiographics.19.suppl_1.g99oc13s147
Abbott JA (2017) Adenomyosis and Abnormal Uterine Bleeding (AUB-A)-Pathogenesis, diagnosis, and management. Best practice & research Clinical obstetrics & gynaecology 40:68-81. https://doi.org/10.1016/j.bpobgyn.2016.09.006
Yeniel O, Cirpan T, Ulukus M, Ozbal A, Gundem G, Ozsener S, Zekioglu O, Yilmaz H (2007) Adenomyosis: prevalence, risk factors, symptoms and clinical findings. Clinical and experimental obstetrics & gynecology 34 (3):163-167
Struble J, Reid S, Bedaiwy MA (2016) Adenomyosis: A Clinical Review of a Challenging Gynecologic Condition. Journal of minimally invasive gynecology 23 (2):164-185. https://doi.org/10.1016/j.jmig.2015.09.018
Garcia L, Isaacson K (2011) Adenomyosis: review of the literature. Journal of minimally invasive gynecology 18 (4):428-437. https://doi.org/10.1016/j.jmig.2011.04.004
Choi EJ, Cho SB, Lee SR, Lim YM, Jeong K, Moon HS, Chung H (2017) Comorbidity of gynecological and non-gynecological diseases with adenomyosis and endometriosis. Obstetrics & gynecology science 60 (6):579-586. https://doi.org/10.5468/ogs.2017.60.6.579
Bergeron C, Amant F, Ferenczy A (2006) Pathology and physiopathology of adenomyosis. Best practice & research Clinical obstetrics & gynaecology 20 (4):511-521. https://doi.org/10.1016/j.bpobgyn.2006.01.016
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 obstetricia et gynecologica Scandinavica 89 (11):1374-1384. https://doi.org/10.3109/00016349.2010.512061
Meredith SM, Sanchez-Ramos L, Kaunitz AM (2009) Diagnostic accuracy of transvaginal sonography for the diagnosis of adenomyosis: systematic review and metaanalysis. Am J Obstet Gynecol 201 (1):107.e101-106. https://doi.org/10.1016/j.ajog.2009.03.021
Cunningham RK, Horrow MM, Smith RJ, Springer J (2018) Adenomyosis: A Sonographic Diagnosis. Radiographics: a review publication of the Radiological Society of North America, Inc 38 (5):1576-1589. https://doi.org/10.1148/rg.2018180080
Dartmouth K (2014) A systematic review with meta-analysis: the common sonographic characteristics of adenomyosis. Ultrasound (Leeds, England) 22 (3):148-157. https://doi.org/10.1177/1742271x14528837
Reinhold C, Atri M, Mehio A, Zakarian R, Aldis AE, Bret PM (1995) Diffuse uterine adenomyosis: morphologic criteria and diagnostic accuracy of endovaginal sonography. Radiology 197 (3):609-614. https://doi.org/10.1148/radiology.197.3.7480727
Kepkep K, Tuncay YA, Goynumer G, Tutal E (2007) Transvaginal sonography in the diagnosis of adenomyosis: which findings are most accurate? Ultrasound in obstetrics & gynecology: the official journal of the International Society of Ultrasound in Obstetrics and Gynecology 30 (3):341-345. https://doi.org/10.1002/uog.3985
Bazot M, Darai E, Rouger J, Detchev R, Cortez A, Uzan S (2002) Limitations of transvaginal sonography for the diagnosis of adenomyosis, with histopathological correlation. Ultrasound in obstetrics & gynecology: the official journal of the International Society of Ultrasound in Obstetrics and Gynecology 20 (6):605-611. https://doi.org/10.1046/j.1469-0705.2002.00852.x
Hamimi A (2015) What are the most reliable signs for the radiologic diagnosis of uterine adenomyosis? An ultrasound and MRI prospective. The Egyptian Journal of Radiology and Nuclear Medicine 46 (4):1349-1355. https://doi.org/10.1016/j.ejrnm.2015.09.007
Salem S, Cargill Y, Fong K (2016) Joint CAR/SOGC Statement on Performing Ultrasound Examinations of the Female Pelvis. Journal of obstetrics and gynaecology Canada: JOGC = Journal d’obstetrique et gynecologie du Canada: JOGC 38 (1):84-93. https://doi.org/10.1016/j.jogc.2015.10.001
Agostinho L, Cruz R, Osorio F, Alves J, Setubal A, Guerra A (2017) MRI for adenomyosis: a pictorial review. Insights into imaging 8 (6):549-556. https://doi.org/10.1007/s13244-017-0576-z
Novellas S, Chassang M, Delotte J, Toullalan O, Chevallier A, Bouaziz J, Chevallier P (2011) MRI characteristics of the uterine junctional zone: from normal to the diagnosis of adenomyosis. AJR American journal of roentgenology 196 (5):1206-1213. https://doi.org/10.2214/ajr.10.4877
Bazot M, Cortez A, Darai E, Rouger J, Chopier J, Antoine JM, Uzan S (2001) Ultrasonography compared with magnetic resonance imaging for the diagnosis of adenomyosis: correlation with histopathology. Human reproduction (Oxford, England) 16 (11):2427-2433
Disclosures
The authors have no disclosures.
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Sam, M., Raubenheimer, M., Manolea, F. et al. Accuracy of findings in the diagnosis of uterine adenomyosis on ultrasound. Abdom Radiol 45, 842–850 (2020). https://doi.org/10.1007/s00261-019-02231-9
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00261-019-02231-9