Quantitative Ultrasound Measurement of Endometrial Waves in Adenomyosis Versus Women with Normal Uteri - the Waves Study

Abstract

<h3>Study Objective</h3> Measurement and analysis of uterine contractions by quantitative 2D transvaginal ultrasound measurements in women with abnormal uteri due to adenomyosis versus women with normal uteri. <h3>Design</h3> Multi-centre prospective observational cohort study. <h3>Setting</h3> Outpatient gynaecology department of participating centres. <h3>Patients or Participants</h3> 29 women with adenomyosis with a natural menstrual cycle were compared to 70 women with normal uteri and regular menstrual cycles. Patients were included from September 2014 up to January 2022. <h3>Interventions</h3> Patients underwent a 4-minute 2D transvaginal ultrasound of the uterus in mid-sagittal section. Uterine motion analysis was implemented by a dedicated speckle tracking and strain analysis algorithm; with frequency, amplitude, coordination and velocity -related features extracted from the derived signals to characterise the uterine contractions. Measurements were carried out at different points of the menstrual cycle (menstrual, early follicular, periovulatory and early and late luteal phases. <h3>Measurements and Main Results</h3> Results differed most significantly between groups in the periovulatory phase, with women with adenomyosis showing lower frequency (1.44 vs. 1.79 contractions/minute, p=0.025), higher amplitude (0.09 vs. 0.04, p=0.000) and lower velocity of uterine contractions (0.62 vs. 0.83 mm/sec, p=0.0008). In the menstrual phase, women with adenomyosis showed a trend toward higher contraction frequency (1.37 vs, 1.33 contractions/minute, p=0.592), amplitude (0.05 vs. 0.04, p=0.259) and velocity (0.72 vs. 0.67, p=0.456). Across all phases, women with adenomyosis showed a trend towards reduced contraction coordination (0.23-0.34 vs. 0.15-0.26). This being statistically significant in the late luteal phase (p=0.018). <h3>Conclusion</h3> Our results confirm differences in uterine movement in abnormal versus healthy uteri. This could add to the aetiological understanding of clinical symptoms of these conditions (i.e. dysmenorrhoea or infertility). The notable difference between groups regarding coordination identifies this feature as a potential prognostic or therapeutic marker. Further research in women with (other) benign uterine disorders will hopefully lead to a better understanding of the clinical implications of abnormal uterine contractility.