Concomitant Adenomyosis Research Articles

Impact of Adenomyosis and Endometriosis on Chronic Pelvic Pain after Niche Repair.

Chronic pelvic pain (CPP) is one of the main isthmocele symptoms, together with abnormal uterine bleeding and secondary infertility. When patients undergo a laparoscopic niche repair surgery, it is important to determine if they present associated pathologies, such as adenomyosis and/or endometriosis, which are also a cause of CPP. A retrospective study was performed on 31 patients with CPP undergoing a laparoscopic niche repair. The pre-operative ultrasound was analyzed to determine the presence of adenomyosis. Endometriosis was histologically diagnosed. CPP outcome was evaluated at early (3-6 months) and late (12 months) post-operative follow ups. In our population of 31 women presenting CPP, only six of them (19.4%) did not have any associated pathology. In the group of 25 patients with associated pathology, 10 (40%) had no benefit from the reconstructive surgery in terms of CPP at early follow-up (3-6 months) and 8 (32%) in the post-operative period at 12 months. Patients with CPP who undergo niche repair should be carefully selected as CPP does not seem to be a good indication for uterine scar repair in patients with concomitant adenomyosis and endometriosis.

Prediction of adenomyosis in patients with uterine fibroids

Aim. To determine the clinical, anamnestic, and immunological predictors of adenomyosis by developing a prognostic model of uterine fibroids with concomitant adenomyosis.
 Materials and methods. A retrospective single-center study was conducted at Kurbatov Novokuznetsk City Clinical Hospital №1, from 2012 to 2019. The model included 284 women with histologically confirmed uterine fibroids, of which 34.9% (99/284) were fibroids with adenomyosis and 65.1% (185/284) were isolated uterine fibroids. Logistic regression was used to develop the mathematical model.
 Results. Predictors of adenomyosis in patients with uterine fibroids have been established: age 43 years and older, concomitant endometrial hyperplasia, chronic inflammatory diseases of the cervix, menometrorrhagia, history of childbirth, history of endometrial disorders, varicose veins of the lower extremities, history of appendectomy, blood serum lactoferrin of more than 1.8 mg/L, interleukin-6 levels more than 2.8 pg/mL. The model has an accuracy of 91%, a sensitivity of 90%, a specificity of 92%, a positive predictive value of 85%, and a negative predictive value of 94%.
 Conclusion. The established predictors of adenomyosis allow for predicting the risk of adenomyosis in patients with uterine fibroids, facilitating effective treatment choices.

Endometrial Histopathology in Abnormal Uterine Bleeding and Its Relation With Thyroid Profile and Endometrial Thickness.

Abnormal uterine bleeding (AUB) is a common complaint in postmenopausal and perimenopausal women, caused by a range of disorders, including structural and systemic diseases. The evaluation of endometrial thickness (ET) via radiological methods, followed by a histopathological examination of the endometrium, is useful for proper diagnosis. Among systemic diseases, thyroid dysfunction, specifically hypothyroidism and hyperthyroidism, contribute significantly to AUB cases. This descriptive cross-sectional study was conducted at Sri Aurobindo Medical College, Indore, Madhya Pradesh, India, over a period of 16 months, from May 2021 to September 2022. Patients presenting with abnormal uterine bleeding and undergoing thyroid function tests (TFTs), ultrasonography, and endometrial biopsy/hysterectomy at the gynecological outpatient department were included. Hospital records were used to obtain clinical details and investigation results. Endometrial thickness and thyroid status were recorded, and descriptive statistics were used to analyze the collected data. This study included 150 patients with abnormal uterine bleeding, with a mean age of 44 years and 80.6% of patients in the premenopausal age group. A total of 48% of patients had a deranged thyroid profile, with hypothyroidism being more common (91.6%). Structural causes of AUB were identified in 81.3% of cases, with adenomyosis (33.65%), concomitant adenomyosis and leiomyoma (31.5%), and leiomyoma (14.8%) being the most common. Endometrial polyps (4.6%) and endometrial carcinoma (0.6%) were also observed and were consistent with the final histopathology. The remaining 18 patients had no structural causes and were categorized as cases of dysfunctional uterine bleeding (DUB). Increased ET was more commonly observed in postmenopausal patients (4.3%) compared to premenopausal patients (0.7%) among those with AUB, while the reverse was true for patients with DUB. Increased ET was commonly associated with hypothyroidism in both groups. Histopathological examination of endometrial biopsies/hysterectomy specimens revealed additional findings in some patients, including hyperplasia of the endometrium with (0.7%) and without atypia (4%), leading to a more accurate diagnosis. AUB is a prevalent condition affecting women in both pre-menopausal and postmenopausal stages, frequently caused by structural anomalies. However, thyroid dysfunction, especially hypothyroidism, is also a significant contributing factor. As such, thyroid function tests (TFTs) are an effective and economical means of identifying potential underlying causes of AUB. Hypothyroidism is frequently associated with increased endometrial thickness, and histopathological examination remains the gold standard for determining the precise cause of AUB.

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

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.

Adenomyosis is an independent risk factor for complications in deep endometriosis laparoscopic surgery

Deep endometriosis (DE) occurs in 15–30% of patients with endometriosis and is associated with concomitant adenomyosis in around 25–49% of cases. There are no data about the effect of the presence of adenomyosis in terms of surgical outcomes and complications. Thus, the aim of the present study was to evaluate the impact of adenomyosis on surgical complications in women with deep endometriosis undergoing laparoscopic surgery. A retrospective cohort study including women referred to the endometriosis unit of a referral teaching hospital. Two expert sonographers preoperatively diagnosed DE and adenomyosis. DE was defined according to the criteria of the International Deep Endometriosis Analysis group. Adenomyosis was considered when 3 or more ultrasound criteria of the Morphological Uterus Sonographic Assessment group were present. Demographical variables, current medical treatment, symptoms, DE location, surgical time, hospital stay and difference in pre and post hemoglobin levels were collected. The Clavien–Dindo classification was used to assess surgical complications, and multivariate analysis was performed to compare patients with and without adenomyosis. 157 DE patients were included into the study; 77 (49.05%) had adenomyosis according to transvaginal ultrasound (TVS) and were classified in the A group, and 80 (50.95%) had no adenomyosis and were classified in the noA group. Adenomyosis was associated with a higher rate of surgical complications: 33.76% (A group) vs. 12.50% (noA group) (p < 0.001). Multivariate analysis showed a 4.56-fold increased risk of presenting complications in women with adenomyosis (CI 1.90–11.30; p = 0.001) independently of undergoing hysterectomy. There was a statistically significant association between the number of criteria of adenomyosis present in each patient and the proportion of patients presenting surgical complications (p < 0.001). Adenomyosis is an independent preoperative risk factor for surgical complications in DE surgery after adjustment for known demographic, clinical and surgical risk factors.

Association and Management of Adenomyosis Amongst Patients with Asherman's Syndrome

Study Objective To provide the first characterization of concomitant Asherman's syndrome and adenomyosis, and subsequent obstetrical outcomes. Design A retrospective cohort study from 01 January 2015 to 01 March 2019. Setting A community teaching hospital affiliated with a large academic medical center. Patients or Participants 227 Asherman's syndrome patients with available hysteroscopy and pelvic ultrasound reports. Interventions Determinants of adenomyosis and the impact of adenomyosis on fertility and obstetrical outcomes in Asherman's syndrome patients. Measurements and Main Results A telephone survey and confirmatory chart review were conducted to obtain information on patients’ demographics, gynecologic and obstetric history, past medical and surgical history, and Asherman's syndrome management. Adenomyosis was the most common co-occurring uterine finding, detected in 39 Asherman's patients. The overall primary symptom was infertility. Adenomyosis patients reported a different menstrual pattern than patients with Asherman's syndrome only. Adenomyosis prevalence trended higher with increasing Asherman's severity, but there were no significant independent predictors of adenomyosis. In this cohort, 77 patients attempted conception and produced 87 pregnancies, 13 of which were ongoing at study conclusion. Age (OR 0.7, 95% CI 0.5-0.9) and use of assisted reproductive technology (OR 0.1, 95% CI 0.02-0.995) were negatively associated with pregnancy. Postpartum dilation & curettage/dilation & evacuation was a risk factor for miscarriage (OR 13.6, 95% CI 1.4-129.5). Age (OR 0.9, 95% CI 0.8-0.988) and severe Asherman's disease (OR 0.1, 95% CI 0.001-0.1) were negatively associated with live birth. Adenomyosis was not an independent predictor of pregnancy rate, miscarriage rate, or live birth rate among Asherman's patients. Conclusion Adenomyosis is relatively common in Asherman's syndrome patients. Any distinct detriment to fertility from adenomyosis may be overshadowed by the lasting effects of Asherman's adhesions when these diseases occur together. Larger studies to establish management guidelines for concomitant disease are needed.

Concomitant Adenomyosis among Patients with Asherman Syndrome

To characterize obstetric outcomes for concomitant Asherman syndrome and adenomyosis. A retrospective cohort study. A community teaching hospital affiliated with a large academic medical center. A total of 227 patients with Asherman syndrome with available hysteroscopy and pelvic ultrasound reports. Telephone survey to assess and compare the obstetric outcomes of patients with Asherman syndrome with concomitant adenomyosis (Group A) vs patients with Asherman syndrome without concomitant adenomyosis (Group B). A telephone survey and confirmatory chart review were conducted to obtain information on patients' demographics, gynecologic and obstetric history, past medical and surgical history, and Asherman syndrome management. Adenomyosis was a common sonographic finding, detected in 39 patients with Asherman syndrome (17.2%). In this cohort, 77 patients attempted pregnancy and produced 87 pregnancies. Age (odds ratio [OR] 0.67; 95% confidence intervals [CI], 0.52-0.86) was negatively associated with a pregnancy outcome. Age (OR 0.83; 95% CI, 0.73-0.95) and severe Asherman disease (OR 0.06; 95% CI, <0.01-0.99) were negatively associated with a live birth outcome. Adenomyosis was not an independent predictor of pregnancy rate, miscarriage rate, or live birth rate among patients with Asherman syndrome. Adenomyosis is relatively common in patients with Asherman syndrome. Adenomyosis does not seem to add any distinct detriment to fertility among patients with Asherman syndrome.

Особливості клінічного перебігу міоми матки у жінок репродуктивного віку

The objective: in this work represented part of materials of department rehabilitation of reproductive function for the examination and treatment of 250 patients with uterine fibrods in order to study and determine in detail the predictors of the disease, develop methods of treatment (conservative and surgical), as well as rehabilitation of the reproductive function, depending on the type and localization of the nodes. Materials and methods. The analysis of the anamnestic data, taking into account both objective and subjective data, analysis of anamnestic data of close relatives (maternal and paternal lines), concomitant genital and extragenital pathology is carried out. Results. The most numerical group of patients with uterine fibroids, according to our data, in the age groups of 26–35 years (32%) is 36–40 years (28.4%), which are the most socially and reproductively active. In this category, women with a high education of 33.6% and social status (30.4% and 22.4%) prevailed. The transferred inflammatory diseases of the genitals were noted in 48% of the examined, weighed gynecological anamnesis (abortions, miscarriages) were noted in 42.4%. Conclusion. Also for this category of patients is characterized by a high percentage of endometrial pathology – 60.8%, as well as concomitant adenomyosis – 34% and adhesion process of pelvic organs – 26.8%. Key words: clinical course, uterine fibroids, reproductive age.

489 - Investigational Treatment of Uterine Fibroids with Transcervical Radiofrequency Ablation in a Patient with Concomitant Adenomyosis

Study Objective: To describe a case in which radiofrequency ablation of uterine fibroids led to symptom relief in a patient with adenomyosis.

Coexistence of adenomyosis and endometrioid endometrial cancer: Role in surgical guidance and prognosis estimation.

The aim of the current study was to diagnose the concomitant presence of adenomyosis (AM) in endometrioid endometrial cancer (EEC) in order to evaluate its value as an oncological prognostic marker. A retrospective analysis of 289 patients diagnosed with EEC who underwent total hysterectomy, bilateral salpingo-oophorectomy and pelvic-lymphadenectomy was conducted. The total cohort included 37 patients in Group A (those with concomitant AM and EEC) and 252 patients in Group B (those affected only by EEC). The following factors were evaluated: Presence or absence of AM, tumor grade, depth of myometrial invasion, tumor size, lymphovascular space involvement, lymph node status, peritoneal cytology, concomitant detection of endometrial atypical-hyperplasia or polypoid endometrial features and tumor stage according to the International Federation of Gynecology and Obstetrics (FIGO) classification. Uterine examination of different sections of uterine cervix, corpus, myomas and cervical or endometrial polyps was performed. The diagnosis of AM was confirmed when the distance between the lower border of the endometrium and the foci of the endometrial glands and stroma was >2.5 mm. Parametric and nonparametric statistical tests were performed when possible; continuous variables were analyzed using a Student's t-test, and categorical variables were analyzed by the χ2 test or Fisher's exact test. The association between FIGO stage and group was determined to be significant: 83.8% of Group A patients were categorized as FIGO stage I, vs. 68.7% of Group B patients. In addition, Group A was associated with lower grades in FIGO stage, myometrial invasion, lymphovascular space involvement, lymph node involvement and tumor size. The findings suggest that the intraoperative evaluation of the presence of AM in patients with EEC may aid surgeons in estimating oncological risk and in selecting the most appropriate surgical treatment.

Differences in clinical characteristics for the determination of adenomyosis coexisting with leiomyomas.

The objective of the analysis was to determine the characteristics that distinguish women with adenomyosis and leiomyomas from those with leiomyoma only from a sample who underwent hysterectomy for benign uterine diseases. This retrospective study was based on the analysis of medical records of 75 women with both adenomyosis and uterine leiomyomas and 218 women with leiomyomas only, diagnosed by histologic analysis of uterine specimens. Results of multivariate logistic regression analyses showed that women with both adenomyosis and leiomyomas had a higher gravity (odds ratio [OR] 1.16, 95% confidence interval [CI] 1.01-1.33) and more frequent pelvic pain (OR 0.38, 95% CI 0.21-0.7) compared with women with leiomyomas only. Postmenopausal bleeding was commonly reported in women with adenomyosis and leiomyomas. No significant difference was observed between the two groups in terms of menorrhagia and metrorrhagia and the preoperative diagnosis of prolapse. The presence of concomitant adenomyosis may cause different clinical symptomatology.

Risk factors for adenomyosis, leiomyoma and concurrent adenomyosis and leiomyoma.

To evaluate the risk factors for adenomyosis, leiomyoma and concomitant adenomyosis and leiomyoma in patients with treatment-resistant menometrorrhagia. A retrospective study was conducted on 129 women who underwent abdominal hysterectomy for treatment-resistant menometrorrhagia. The patients were divided into four groups according to the postoperative histopathology: concomitant adenomyosis and leiomyoma (n = 33), adenomyosis only (n = 26), leiomyoma only (n = 48) and controls (n = 22). Patients without any organic uterine pathology constituted the control group. Age at menarche was higher in the concomitant adenomyosis and leiomyoma group compared to the adenomyosis only group (P = 0.006). The mean age (P = 0.007), age at menarche (P = 0.001) and gravidity (P = 0.001) were higher in the concomitant adenomyosis and leiomyoma group compared to the leiomyoma only group. Preoperative hemoglobin was lower in the concomitant adenomyosis and leiomyoma, adenomyosis only, and leiomyoma only groups than the control group (P < 0.008). On receiver operating characteristic analysis, hemoglobin <10.9 mg/dL had a sensitivity and specificity of 77% and 70%, respectively, in discrimination of any uterine organic pathology, including adenomyosis only, leiomyoma only, and concomitant adenomyosis and leiomyoma, from the control group. Patients in the adenomyosis group were older (OR, 1.20; 95%CI: 1.05-1.50) and had a lower age at menarche (OR, 0.42; 95%CI: 0.19-0.89) than the other groups. Preoperative anemia may be a useful predictor of adenomyosis. Older patients, and patients who had a lower age at menarche, were also more likely to have adenomyosis.

Clinical characteristics indicating adenomyosis coexisting with leiomyomas: a retrospective, questionnaire-based study

To elucidate the clinical profile of a concomitant diagnosis of adenomyosis in women with leiomyomas. Retrospective questionnaire-based study. Academic medical center. The study sample comprised a total of 560 women: 159 women with adenomyosis and leiomyomas and 401 women with leiomyomas alone. Mailing of a symptom questionnaire. Comparison of women undergoing hysterectomy with adenomyosis and leiomyomas and women with leiomyomas alone. Women with a concomitant diagnosis of adenomyosis and leiomyomas had significantly higher scores for disease burden during the menstrual period before surgery: heavy bleeding episodes and passing blood clots. Furthermore, women with adenomyosis and leiomyomas reported higher scores of distress regarding pelvic pain occurring during the menstrual period and pelvic pain not associated with the menstrual cycle. Moreover, in multivariate analysis, older age (odds ratio [OR] 1.10, 95% confidence interval [CI] 1.04-1.18), gravidity (OR 1.44, 95% CI 1.12-1.74), and pelvic pain occurring during the menstrual period (OR 1.27, 95% CI1.06-1.54) increase the odds of having adenomyosis and not only leiomyomas. Adenomyosis contributes to symptomatology in women with concomitant adenomyosis and leiomyomas.

Technical Eligibility for Treatment of Magnetic Resonance-guided Focused Ultrasound Surgery

This study was designed to evaluate the technical eligibility for magnetic resonance-guided focused ultrasound surgery (MRgFUS) treatment of women with symptomatic fibroids. Technical eligibility for MRgFUS treatment without mitigation techniques was evaluated retrospectively in 783 premenopausal women (median age, 44.2 years) with symptomatic fibroids who applied for uterine artery embolization (UAE) at our institution from 2001 to 2012. Technical eligibility for MRgFUS was defined as primary study endpoint. Technical ineligibility was assessed on the basis of MRI criteria, such as bowel interposition/foreign material in the ultrasound beam path, more than five fibroids, distance from fibroid to sacral bone surface, fibroid size/shape, severe concomitant adenomyosis or extensive cutaneous scars in accordance to the US Food and Drug Administration approvals. Secondary study endpoint was defined as evaluation of the most frequent exclusion criteria and differences in technical eligibility for MRgFUS and UAE. On the basis of MRI, 38.9% of women who applied for UAE were found to be technically eligible for MRgFUS treatment without mitigation techniques. Most frequent reason for ineligibility was bowel interposition in the ultrasound beam path (60.4%). Differences in technical eligibility for MRgFUS (38.9%) and UAE (99.2%) were significant (P < 0.001). MRgFUS treatment is technically possible in up to 40% of women with symptomatic fibroids. The most frequent exclusion criterion is the presence of bowel in the ultrasound beam path.

Uterine Artery Embolization versus Myomectomy: Impact on Quality of Life—Results of the FUME (Fibroids of the Uterus: Myomectomy versus Embolization) Trial

This study was designed to compare quality of life (QoL) outcomes after uterine artery embolization (UAE) or myomectomy. Women with symptomatic fibroids diagnosed by ultrasound who wished to preserve their uterus were randomized to myomectomy (n=81) or UAE (n=82). Endpoints at 1 year were QoL measured by a validated questionnaire, hospital stay, rates of complications, and need for reintervention. UAE patients had shorter hospitalization (2 vs. 6 days, p<0.001). By 1 year postintervention, significant and equal improvements in QoL scores had occurred in both groups (myomectomy n=59; UAE n=61). There had been two (2.9%) major complications among UAE versus 6 (8%) among myomectomy patients (not significant). By 2 years, among UAE patients (n=57) there were eight (14.0%) reinterventions for inadequate symptom control compared with one (2.7%) among myomectomy patients (n=37). Half of the women who required hysterectomy had concomitant adenomyosis missed by US. UAE and myomectomy both result in significant and equal improvements in QoL. UAE allows a shorter hospital stay and fewer major complications but with a higher rate of reintervention.

MR imaging features of uterine adenomyomas

To evaluate the magnetic resonance (MR) imaging features of uterine adenomyoma in comparison with histopathologic findings. MR images of seven patients who had surgically proven uterine adenomyoma were retrospectively reviewed by two radiologists in consensus regarding the morphologic appearance, including tumor size, location, margin, presence of concomitant adenomyosis, presence and signal intensity of cavity within tumor, and signal intensity and enhancement pattern of solid portion of tumor. MR imaging findings were correlated with histopathologic findings. Tumor location was submucosal in three cases, subserosal in two, and mixed mural/subserosal in two. All tumors were well circumscribed on T2-weighted images and contrast-enhanced fat-suppressed T1-weighted images. In six cases, well defined cavities of high signal intensity, which reflected hemorrhagic cavities pathologically, were demonstrated within the tumors on T1-weighted images. Concomitant adenomyosis was observed in five cases. Solid portion of all tumors except hemorrhagic cavities exhibited iso-signal intensity on T1-weighted images, various signal intensity on T2-weighted images, and homogeneous enhancement on contrast-enhanced fat-suppressed T1-weighted images in five cases. When MR imaging shows a well circumscribed mass with hemorrhagic cavities of high signal intensity on T1-weighted images and concomitant adenomyosis in the uterus, adenomyoma should be considered in the differential diagnosis.

Fibroids Treated With Uterine Artery Embolization: Do Imaging Findings Correlate With Patient Outcomes?

ObjectiveTo evaluate whether changes on ultrasound in uterine and fibroid volume and fibroid vascularity correlate with changes in symptom severity and health-related quality of life (HRQL) perceived by patients after uterine artery embolization (UAE). Materials and MethodsSixty-four women (mean age 45.3) with symptomatic uterine fibroids underwent UAE at the Hysterectomy Alternatives (HAlt) clinic in Winnipeg, Manitoba. They completed a validated questionnaire assessing symptom severity and HRQL at baseline and at three and six months post-embolization, and ultrasound was also performed at these intervals. Changes in uterine and fibroid volume were compared with changes in symptom severity and HRQL. Data from patients with residual fibroid vascularity, extremes of baseline fibroid volume, and concomitant adenomyosis were analyzed to determine whether the outcomes were different in these patient groups. ResultsChanges in uterine and fibroid volumes did not correlate with changes in symptom severity or HRQL after UAE (P> 0.05). Residual fibroid vascularity was a negative predictor of reduction in uterine and fibroid volume (P< 0.05), but did not affect changes in symptom severity or HRQL. Extremes of baseline volume in the dominant fibroid did not affect symptom severity or HRQL. Patients with concomitant adenomyosis experienced greater improvement in symptoms than those without adenomyosis (P< 0.05). ConclusionWe found poor correlation between imaging findings and patient- perceived outcomes after UAE. Ultrasound cannot be used to predict improvement in symptoms or HRQL after UAE.

Characteristics indicating adenomyosis coexisting with leiomyomas: a case-control study

Adenomyosis is rarely diagnosed before hysterectomy and commonly coexists with uterine leiomyomas. The objective of this study was to identify distinct features of a concurrent diagnosis of adenomyosis in women with uterine leiomyomas. We conducted a case-control study of women undergoing hysterectomy with a histologic diagnosis of both adenomyosis and leiomyomas and women with uterine leiomyomas but no adenomyosis. A retrospective medical record review of hospital and ambulatory records was performed to ascertain sociodemographic and anthropometric variables, as well as to confirm intraoperative and pathologic findings. Our study sample comprised 255 patients, 85 women with adenomyosis and leiomyomas and 170 women with only leiomyomas. In multivariable logistic regression analyses, women with adenomyosis and leiomyomas were more likely to have more pelvic pain [odds ratio (OR) 3.4, 95% confidence interval (CI) 1.8-6.4], have less fibroid burden (OR per doubling in fibroid size 0.6, 95% CI 0.5-0.8), were more likely to be parous (OR 3.8, 95% CI 1.4-10.5) and have lower body mass index (OR per 5 unit increase in BMI 0.8, 95% CI 0.6-1.0) when compared with women with leiomyomas alone. Women undergoing hysterectomy with both adenomyosis and leiomyomas have a number of different clinical features compared with women with only leiomyomas at the time of hysterectomy. Women with substantial pain despite a smaller fibroid burden may be more likely to have concomitant adenomyosis.

MR Reproducibility in the Assessment of Uterine Fibroids for Patients Scheduled for Uterine Artery Embolization

Magnetic resonance imaging (MRI) is increasingly applied in the evaluation of uterine fibroids. However, little is known about the reproducibility of MRI in the assessment of uterine fibroids. This study evaluates the inter- and intraobserver variation in the assessment of the uterine fibroids and concomitant adenomyosis in women scheduled for uterine artery embolization (UAE). Forty patients (mean age: 44.5 years) with symptomatic uterine fibroids who were scheduled for UAE underwent T(1)- and T(2)-weighted MRI. To study inter- and intraobserver agreement 40 MR images were evaluated independently by two observers and reevaluated by both observers 4 months later. Inter- and intraobserver agreement was calculated using Cohen's kappa statistic and intraclass correlation coefficient for categorical and continuous variables, respectively. Inter-observer agreement for uterine volumes (kappa = 0.99, p < 0.0001), dominant fibroid volumes (kappa = 0.98, p <or= 0.0001), and number of fibroids (kappa = 0.88; CI, 0.77-0.93; p < 0.0001) was excellent. For the T(1)- and T(2)-weighted signal intensity of the dominant fibroid there was good agreement between the observers (87%; 95% CI, 71.9%-95.6%) and the intraobserver agreement was good for observer A (95%; 95% CI, 83.1%-99.4%) and moderate for observer B (kappa = 0.47). The interobserver agreement with respect to the presence of adenomyosis was good (kappa = 0.73, p < 0.0001), while both intraobserver agreements were fair to moderate (observer A, kappa = 0.55, p = 0.0003; and observer B, kappa = 0.66, p < 0.0001). In conclusion, MRI criteria used for the selection of suitable UAE patients show good inter- and intraobserver reproducibility.