Ultrasound Diagnosis Of Adenomyosis Research Articles

Type and Location of Adenomyosis in Women with Recurrent Pregnancy Loss: A Transvaginal Ultrasonographic Assessment.

The current knowledge on adenomyosis as a risk factor for RPL is very scant. Overall 120 women were included in this retrospective observational study. They were divided in three groups each of which consisted of 40 subjects: Group 1: women with RPL who were diagnosed to have adenomyosis on transvaginal ultrasound (TVS); Group 2: patients with RPL without ultrasonographic findings of adenomyosis; Group 3: patients with ultrasound diagnosis of adenomyosis without RPL and at least one live birth pregnancy. The copresence of endometriosis was also investigated. Among women with RPL, patients with adenomyosis (Group 1) had higher number of pregnancy losses (p = 0.03) and lower age at first pregnancy loss (p = 0.03) than women without adenomyosis (Group 2). Moreover, they had more frequently primary RPL (p = 0.008). Adenomyosis of the inner myometrium was found more frequently (p = 0.04) in patients of Group 1 than in patients of Group 3 in which adenomyosis was mainly in the outer myometrium (p= 0.02). No differences were found in the severity of adenomyosis between these two groups of women. TVS findings for endometriosis were observed more frequently in women with adenomyosis without RPL (Group 3) than in the other two groups of patients. Adenomyosis can be a factor involved in RPL. Differences in adenomyosis localization are associated with different risks for RPL. Patients with RPL should be investigated for the presence of adenomyosis and also for the type and localization of the disease in the different myometrial layers.

Ultrasound diagnosis of adenomyosis – a blinded validation study of the 2022 MUSA guidelines

Ultrasound diagnosis of adenomyosis – a blinded validation study of the 2022 MUSA guidelines

OC06.06: A retrospective study on the ultrasound diagnosis of adenomyosis and myoma based on the MUSA consensus statement with histopathological correlation

OC06.06: A retrospective study on the ultrasound diagnosis of adenomyosis and myoma based on the MUSA consensus statement with histopathological correlation

Consensus on revised definitions of Morphological Uterus Sonographic Assessment (MUSA) features of adenomyosis: results of modified Delphi procedure.

ABSTRACTObjectivesTo evaluate whether the Morphological Uterus Sonographic Assessment (MUSA) features of adenomyosis need to be better defined and, if deemed necessary, to reach consensus on the updated definitions.MethodsA modified Delphi procedure was performed among European gynecologists with expertise in ultrasound diagnosis of adenomyosis. To identify MUSA features that might need revision, 15 two‐dimensional (2D) video recordings (four recordings also included three‐dimensional (3D) still images) of transvaginal ultrasound (TVS) examinations of the uterus were presented in the first Delphi round (online questionnaire). Experts were asked to confirm or refute the presence of each of the nine MUSA features of adenomyosis (described in the original MUSA consensus statement) in each of the 15 videoclips and to provide comments. In the second Delphi round (online questionnaire), the results of the first round and suggestions for revision of MUSA features were shared with the experts before they were asked to assess a new set of 2D and 3D still images of TVS examinations and to provide feedback on the proposed revisions. A third Delphi round (virtual group meeting) was conducted to discuss and reach final consensus on revised definitions of MUSA features. Consensus was predefined as at least 66.7% agreement between experts.ResultsOf 18 invited experts, 16 agreed to participate in the Delphi procedure. Eleven experts completed and four experts partly finished the first round. The experts identified a need for more detailed definitions of some MUSA features. They recommended use of 3D ultrasound to optimize visualization of the junctional zone. Fifteen experts participated in the second round and reached consensus on the presence or absence of ultrasound features of adenomyosis in most of the still images. Consensus was reached for all revised definitions except those for subendometrial lines and buds and interrupted junctional zone. Thirteen experts joined the online meeting, in which they discussed and agreed on final revisions of the MUSA definitions. There was consensus on the need to distinguish between direct features of adenomyosis, i.e. features indicating presence of ectopic endometrial tissue in the myometrium, and indirect features, i.e. features reflecting changes in the myometrium secondary to presence of endometrial tissue in the myometrium. Myometrial cysts, hyperechogenic islands and echogenic subendometrial lines and buds were classified unanimously as direct features of adenomyosis. Globular uterus, asymmetrical myometrial thickening, fan‐shaped shadowing, translesional vascularity, irregular junctional zone and interrupted junctional zone were classified as indirect features of adenomyosis.ConclusionConsensus between gynecologists with expertise in ultrasound diagnosis of adenomyosis was achieved regarding revised definitions of the MUSA features of adenomyosis and on the classification of MUSA features as direct or indirect signs of adenomyosis. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

The use of the myometrial-cervical ratio in the ultrasound diagnosis of adenomyosis - A validation study.

Adenomyosis is a benign disorder defined by ectopic endometrial glands within the uterine myometrium. A study by Mooney et al reported the myometrial-cervical ratio (MCR), a novel ultrasound measurement that was found to improve the preoperative diagnosis of adenomyosis. To validate the association between sonographic MCR and adenomyosis confirmed on histopathology in an independent patient group. Single-centre retrospective cohort study including women who underwent hysterectomy between 1 January 2016 and 31 December 2018 for a benign, non-obstetric indication with an ultrasound at the study centre prior to surgery. Clinical details and histopathology were extracted. Ultrasound images were reviewed by a gynaecology ultrasound subspecialist blinded to histological findings. Eight hundred eighty-seven patients underwent hysterectomy in the study period for eligible indications; 317 had an ultrasound at the study centre and were included. There was no statistically significant association between the MCR and adenomyosis on histology when all patients were included; however, increased MCR was associated with adenomyosis when those with fibroids on ultrasound were excluded. The area under the receiver operating characteristic for this model was 0.614 (95% CI: 0.53 to 0.69). The optimal MCR cut-point in this subgroup was 1.79, which achieved 55.6% sensitivity and 62.8% specificity, with 58.5% correctly classified. There was no significant difference in MCR compared to traditional ultrasound markers of adenomyosis. In a population undergoing hysterectomy for benign and non-obstetric indications, the MCR applied to preoperative ultrasound was only weakly associated with a histological diagnosis of adenomyosis.

P–315 Ultrasound diagnosis of adenomyosis: impact on pregnancy rate in ivf cycles with donated oocytes

Abstract Study question The aim was to evaluate in patients who underwent embryo transfer (ET) in an oocyte donation cycle, the impact of adenomyosis, diagnosed by transvaginal sonographic (TVS), on the implantation rate. Summary answer We observed a slightly higher miscarriage rate in the first trimester in patients with adenomyosis in particular in the diffuse type. What is known already What we know from literature is that there are pro studies such as Costello and Vercellini’s which show a reduced pregnancy rate and birth rate, and cons studies which find no effects at all of adenomyosis on IVF treatments. However, both show an increased risk of miscarriage and obstetric complications Study design, size, duration This prospective observational study involved a total of 72 patients: 33 with adenomyosis and 39 without adenomyosis from June 2019 to December 2020. All had a workup which included history, pelvic exam and 2/3D TVS scan which was saved as images, videoclips and volumes and stored. The off line evaluation was performed blind to IVF indication and outcomes by expert sonographer, who assessed the presence or absence of TVS signs of adenomyosis. Participants/materials, setting, methods All the patients aged ≤ 45 years old undergoing, for several personal problems, their first oocyte donation at IVI center Rome.Patients were divided into 2 groups according to findings on a baseline pre-treatment TVS: patients with and without adenomyosis. In the patients with adenomyosis, the disease was further classified according to type (diffuse,focal), localization (inner and outer myometrium) and extension inside the uterus (mild, moderate, severe) and correlated to pregnancy rate and outcome Main results and the role of chance A total of 72 patients were included in this study: 33 with adenomyosis and 39 without adenomyosis. The presence, type and degree of adenomyosis doesn’t show a correlation to embryo implantation rate (64.1% in the control group vs 63.6% in adenomyosis group). However we found an increased risk of early miscarriage in the patients with adenomyosis ( 12% in the control group vs 23.8% in adenomyosis group). Women with adenomyosis that infiltrated only the external myometrium showed a lower pregnancy rate (40%) compared to those who had the involvement of only the inner myometrium (77,7%). The presence of ultrasound findings of focal disease was associated with a lower pregnancy rate (53,3%) compared to the diffuse disease (72,2%); We observed a slightly higher miscarriage rate in the first trimester in patients with adenomyosis in particular in the diffuse type .The presence, type and degree of adenomyosis doesn’t show a correlation to embryo implantation rate. Limitations, reasons for caution Most of the patients included in our study has an age > 40. This could determine an increased number of high-risk pregnancies. Wider implications of the findings: Results of this study may be used to evaluate the impact of different medical or surgical treatment in women with adenomyosis undergoing IVF. Trial registration number Not applicable

Three-dimensional ultrasound diagnosis of adenomyosis is not associated with adverse pregnancy outcome following single thawed euploid blastocyst transfer: prospective cohort study.

The objectives of this study were (1) to assess the prevalence of ultrasound (US) features of adenomyosis in an infertile population undergoing in-vitro fertilization (IVF), (2) to define the inter- and intrarater agreement of three-dimensional (3D) US assessment of adenomyosis, and (3) to evaluate sonographic features of adenomyosis with respect to pregnancy outcome following transfer of a single thawed euploid blastocyst. This was a prospective cohort study. Subjects scheduled to undergo a single thawed euploid blastocyst transfer between April and December 2017 at a large IVF center were eligible for inclusion. Enrolled subjects underwent endometrial preparation for frozen embryo transfer. 3D-US was performed on the day prior to embryo transfer, with images stored for subsequent evaluation. Subjects then underwent transfer of a single thawed euploid blastocyst, and pregnancy outcomes were collected. All 3D-US volumes were de-identified and reviewed independently by five reproductive endocrinologists/infertility specialists with expertise in gynecological US for the presence of seven sonographic features of adenomyosis: global uterine enlargement, myometrial wall asymmetry, heterogeneous echogenicity, irregular junctional zone, myometrial cysts, fan-shaped shadowing and ill-defined myometrial lesions. Adenomyosis was considered to be present if the majority of the reviewers noted at least one of the seven sonographic features. Inter- and intrarater agreement was evaluated using Fleiss's kappa. Clinical and cycle characteristics of subjects with and those without adenomyosis were compared. The primary outcome of interest was live birth rate. Secondary outcomes included clinical pregnancy rate and miscarriage rate. Logistic regression analysis was performed to account for potential confounders. A total of 648 subjects were included. The prevalence of adenomyosis on US was 15.3% (99/648). On retrospective chart review, very few patients with adenomyosis had symptoms. The inter- and intrarater agreement amongst five independent specialists conducting the 3D-US assessments of adenomyosis were poor (κ = 0.23) and moderate (κ = 0.58), respectively. Subjects with adenomyosis were older (37.1 vs 35.9 years, P = 0.02) and more likely to undergo a gonadotropin-releasing hormone agonist downregulation protocol when compared with those without adenomyosis (12.1% vs 5.1%, P = 0.02). Clinical pregnancy (80.0% vs 75.0%) and live birth (69.5% vs 66.5%) rates were similar between the groups. When adjusting for potential confounders, there was no difference in the rate of clinical pregnancy (adjusted odds ratio (aOR), 1.47 (95% CI, 0.85-2.56)), miscarriage (aOR, 1.3 (95% CI, 0.62-2.72)) or live birth (aOR, 1.28 (95% CI, 0.78-2.08)) between subjects with and those without adenomyosis. No individual sonographic marker of adenomyosis was predictive of pregnancy outcome. The inter-rater agreement of 3D-US assessment of adenomyosis is poor. Furthermore, sonographic markers of adenomyosis in asymptomatic patients may not be associated with altered pregnancy outcome following transfer of a single thawed euploid blastocyst. These findings suggest that routine screening for asymptomatic adenomyosis in an unselected infertile patient population undergoing frozen embryo transfer may not be warranted. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

Question Mark Sign and Transvaginal Ultrasound Uterine Tenderness for the Diagnosis of Adenomyosis: A Prospective Validation.

To evaluate the diagnostic accuracy of the classic ultrasound (US) signs of adenomyosis, the question mark sign and transvaginal ultrasound (TVUS) uterine tenderness, in the diagnosis of adenomyosis. This was a prospective study including 78 patients waiting for hysterectomy for uterine benign diseases and undergoing preoperative US examinations to evaluate all criteria for US diagnosis of adenomyosis as reported by the consensus statement of the Morphological Uterus Sonographic Assessment group. A US diagnosis of adenomyosis was made in the presence of 2 or more Morphological Uterus Sonographic Assessment features. Moreover, the question mark sign and TVUS uterine tenderness were evaluated. Ultrasound features were compared with the histologic examination, which was considered the reference standard for the diagnosis of adenomyosis. The Cohen κ coefficient was used to measure the accordance between US and histologic results. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of each US feature were calculated. The prevalence of adenomyosis in the sample was 33.3%. The sensitivity, specificity, PPV, NPV, and accuracy of TVUS in the diagnosis of adenomyosis were 77%, 96%, 91%, 89%, and 90%, respectively. Myometrial heterogeneity was the most frequently encountered feature (100%) but showed low specificity (7%). The question mark sign and TVUS uterine tenderness showed sensitivity, specificity, PPV, NPV, and accuracy of 41%, 96%, 83%, 77%, and 69% and 69%, 65%, 66%, 81%, and 67%. The question mark sign and TVUS uterine tenderness are useful tools for the diagnosis of adenomyosis.

CONTROVERSIAL ISSUES OF RADIOLOGIC DIAGNOSIS OF ADENOMYOSIS IN REPRODUCTIVE LOSSES

Aim. The aim is to analyze the data thus far published on the radiologic diagnosis of adenomyosis in patients with reproductive problems in order to determine promising areas for further scientifi c research.Materials and methods. An information search for subsequent analysis was performed using E-Library, PubMed and CochraneLibrary electronic bibliographic databases with the following keywords: “ultrasound diagnosis of adenomyosis”, “MRI adenomyosis”, “junctional zone adenomyosis”, “ultrasound adenomyosis”, “diagnosis adenomyosis”, “magnetic resonance imaging adenomyosis”, “adenomyosis junction”.Results. Imaging techniques are prioritized in diagnosing the initial incidence of adenomyosis. The value of such techniques increases when analyzing the causes of implantation failures. Key issues associated with the modern radiologic diagnosis and monitoring of adenomyosis during treatment have been considered on the basis of the standardization of studies, classifi cation of the disease, assessment of the diagnostic accuracy and prognostic value of imaging techniques in patients with reproductive losses and infertility.Conclusion. Promising areas of scientifi c research are found to be the specifi cation of optimal diagnostic timeframes, informativity of diagnostic criteria for 3D reconstruction, MRI, elastography, angiography, as well as the development of prediction methods for healthy childbearing and monitoring the treatment effectiveness.

Association between ultrasound features of adenomyosis and severity of menstrual pain.

To investigate the association between the ultrasound features of adenomyosis and the severity of menstrual pain. This was a prospective observational study set in the general gynecology clinic of a university teaching hospital between January 2009 and January 2010. A total of 718 consecutive premenopausal women aged between 17 and 55 years attended the clinic and underwent structured clinical and transvaginal ultrasound examinations in accordance with the study protocol. Morphological features of adenomyosis on ultrasound scan were recorded systematically. A quantitative assessment of menstrual pain was made by completion of a numerical rating scale (NRS). One hundred and fifty-seven (21.9% (95% CI, 18.8-24.9%)) women were diagnosed with adenomyosis on ultrasound. Multiple linear regression analysis showed that an ultrasound diagnosis of adenomyosis and ultrasound and laparoscopic diagnoses of endometriosis were significantly associated with menstrual pain when measured by an NRS. In addition, there was a statistically significant positive correlation between the severity of menstrual pain and the number of ultrasound features of adenomyosis seen. Women with ultrasound features of adenomyosis have more severe menstrual pain than do women without these features. The positive correlation between the number of ultrasound features of adenomyosis and the severity of menstrual pain could form the basis of a clinically relevant grading system for adenomyosis. A classification of severity of adenomyosis based on the number of ultrasound features present is a novel concept that should be evaluated prospectively in different populations. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

Ultrasound Diagnosis of Adenomyosis, Leiomyoma or Combined with Histopathological Correlation

Objective: To evaluate the accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the diagnosis of adenomyosis, leiomyoma, or combined adenomyosis and leiomyoma by the use of transvaginal ultrasonography (TVS) compared to the histopathological findings. Subjects and Methods: This is a retrospective study of patients with a preoperative TVS diagnosis of adenomyosis, leiomyoma, or combined. Patients diagnosed with adenomyosis or combined adenomyosis and leiomyoma via TVS underwent hysterectomy. Symptomatic patients diagnosed with adenomyosis and leiomyoma via TVS underwent myomectomy with excision of the surrounding myometrium which contained possible adenomyosis. Following surgery, a histopathological examination was performed by the hospital pathologists. The microscopic diagnosis of the specimen was recorded. Results: TVS diagnosis of adenomyosis was sensitive but not specific. TVS was sensitive, specific, and accurate in the diagnosis of leiomyoma and combined adenomyosis and leiomyoma. Conclusion: This study demonstrated that TVS is a valuable noninvasive method that should be utilized in the diagnosis of leiomyoma and combined adenomyosis and leiomyoma. TVS is sensitive, but is not specific in the diagnosis of adenomyosis only.

Ultrasound diagnosis of adenomyosis, leiomyoma, or combined with histopathological correlation

OBJECTIVE:To evaluate the accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the diagnosis of adenomyosis, leiomyoma, or combined adenomyosis and leiomyoma by the use of transvaginal ultrasonography (TVS) compared to the histopathological findings.SUBJECTS AND METHODS:This is a retrospective study of patients with a preoperative TVS diagnosis of adenomyosis, leiomyoma, or combined. Patients diagnosed with adenomyosis or combined adenomyosis and leiomyoma via TVS underwent hysterectomy. Symptomatic patients diagnosed with adenomyosis and leiomyoma via TVS underwent myomectomy with excision of the surrounding myometrium which contained possible adenomyosis. Following surgery, a histopathological examination was performed by the hospital pathologists. The microscopic diagnosis of the specimen was recorded.RESULTS:TVS diagnosis of adenomyosis was sensitive but not specific. TVS was sensitive, specific, and accurate in the diagnosis of leiomyoma and combined adenomyosis and leiomyoma.CONCLUSION:This study demonstrated that TVS is a valuable noninvasive method that should be utilized in the diagnosis of leiomyoma and combined adenomyosis and leiomyoma. TVS is sensitive, but is not specific in the diagnosis of adenomyosis only.

Transvaginal ultrasound guided biopsies in the diagnosis of pelvic lesions

Uterine arterial embolisation in the management of fibroids can only be carried out if the preoperative diagnosis has been made accurately. It is particularly important to exclude adenomyosis or malignancies. In medicine the gold standard is a histological diagnosis. We have used transvaginal ultrasound guided gun biopsy of the uterus or ovaries in the office setting, in order to obtain a tissue sample for histological conformation of the preliminary ultrasound findings. Twenty two patients scheduled to undergo uterine arterial embolisation with an equivocal ultrasound diagnosis were biopsied. In eight (36.4%) patients the preliminary ultrasound diagnosis of adenomyosis was confirmed histologically, and in nine (40.9%) patients the ultrasound diagnosis of leiomyoma was confirmed histologically. In two patients the ultrasound diagnosis of a benign ovarian mass was confirmed histologically. In the remaining three (13.6%) patients, the preliminary ultrasound diagnosis was incorrect. One patient was thought to have a leiomyoma where the histology was of a benign adenomatoid tumor, another patient was thought to have a sarcoma where the histology was of a leiomyoma, and one patient thought to have adenomyosis was shown to have a normal myometrium. There were no procedure related complications. This simple office based technique is safe, and effective.