Importance of Transvaginal Elastography in the Diagnosis of Uterine Fibroids and Adenomyosis

Abstract

Purpose: To evaluate normal uterine tissue with special regard to age and the presence of uterine fibroids and adenomyosis with transvaginal elastography.

Materials and Methods: In a prospective study elastographic data of the uterus were obtained in 206 unselected women with transvaginal ultrasound. Women who presented without any uterine pathology in ultrasonography were included in a control group, women with uterine fibroids in a uterine fibroid group, and women with adenomyosis in an adenomyosis group. In the control group strain values were measured at two regions of interest (ROIs) placed one upon the other in the anterior inferior uterine segment during a cycle of compression. The maximum strain ratio (ROI1 / ROI2) was stored as the “age index”. In all groups strain values were measured at two ROIs placed side by side in a uterine fibroid (uterine fibroid group) or adenomyosis (adenomyosis group) or healthy homogeneous tissue (control group) and adjacent healthy tissue. Maximum strain ratios (ROI3 / ROI4) were stored as the “lesion index”.

Results: The “age index” was significantly negatively correlated with the age of the women (r = –0.49, p < 0.001). The median “lesion indices” were significantly (p < 0.001) different between the uterine fibroid, adenomyosis and control groups. Median “lesion indices” were 2.65, 0.44 and 1.19, respectively.

Conclusion: The “age index” shows that normal uterine tissue has a certain age-dependent stiffness that increases with age. The “lesion index” allows for the assessment of the presence of a uterine fibroid or adenomyosis and helps to differentiate between both focal findings. Thus the use of elastography in addition to conventional ultrasound could help to diagnose uterine focal lesions and may be useful in preoperative planning.

Zusammenfassung

Ziel: Evaluation von normalem Uterusgewebe mit besonderem Hinblick auf das Alter und Beurteilung des Vorliegens von Myomen und Adenomyose mittels transvaginaler Elastografie.

Material und Methoden: In einer prospektiven Studie wurden bei 206 unselektierten Frauen elastografische Daten des Uterus mit transvaginalem Ultraschall erhoben. Frauen ohne uterine Pathologie im Ultraschall wurden einer Kontrollgruppe zugeteilt, Frauen mit Myom oder Adenomyose einer Myom-bzw. Adenomyosegruppe. In der Kontrollgruppe wurden Strain-Werte an zwei übereinander liegenden Bildbereichen (ROIs) im vorderen unteren Uterinsegment gemessen. Die während eines Kompressionszyklusses ermittelte maximale Strain-Ratio (ROI1 / ROI2) wurde als „Altersindex“ gesichert. In allen Gruppen wurden Strain-Werte an zwei nebeneinander liegenden ROIs gemessen. Im Falle der Myom- und Adenomyosegruppe befand sich jeweils ein ROI innerhalb des Herdbefundes und einer in benachbartem gesundem Gewebe. In der Kontrollgruppe lagen beide ROIs in gesundem Gewebe. Die maximale Strain-Ratio (ROI3 / ROI4) wurde als „Läsionsindex“ gesichert.

Ergebnisse: Der „Altersindex“ war signifikant negativ mit dem Alter einer Frau korreliert (r = – 0,49, p < 0,001). Die medianen „Läsionsindices“ der Myom-, Adenomyose- und Kontrollgruppe waren signifikant unterschiedlich (p < 0,001). Sie betrugen 2,65, 0,44 und 1,19.

Schlussfolgerung: Der „Altersindex“ zeigt, dass normales Uterusgewebe eine gewisse Festigkeit aufweist, die mit dem Alter zunimmt. Der „Läsionsindex“ erlaubt die Beurteilung des Vorliegens von Myomen und Adenomyose und hilft bei deren Differenzierung. Somit könnte die zusätzliche Anwendung von Elastografie zum konventionellen Ultraschall bei der Diagnose uteriner Herdbefunde und der präoperativen Planung helfen.

Key words

elastography - uterus - uterine fibroids - adenomyosis

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