Sonographic Appearance of Adenomyosis
Sushila Arya (US), Sanja Kupesic Plavsic (US)
[Arya] Texas Tech University of Health Sciences at El Paso , [Kupesic Plavsic] Texas Tech University of Health Sciences Center at El Paso
Context: The association between adenomyosis, ART outcomes and pregnancy complications is well established. Objective: The purpose of this retrospective study was to assess the most common sonographic features of adenomyosis and prevalence of coexisting pathology. Methods: Retrospective assessment of 828 transvaginal color Doppler ultrasound exams was performed by single evaluator (SKP) using ViewPoint reporting system. Patients: 132 patients with abnormal uterine bleeding and sonographic signs of adenomyosis were identified. Main Outcomes/Results: The average age was 40.6 years. The average gravidity and parity was 2.8 and 2.2 respectively. In addition to abnormal uterine bleeding, pelvic pain and dysmenorrhea were encountered in 64 (48%) patients respectively. 8 patients (6.1%) were infertile. The uterus was anteverted in 103 (78%) patients. The most common sonographic findings associated with adenomyosis were heterogeneous myometrium with striation and posterior shadowing in 111 (84%), and loss of endometrial-myometrial interface in 111 (84%) patients. Asymmetric myometrial thickening was detected in 106 (80.4%), and globular uterus in 100 (75.5%) patients. 76 (57.5%) patients had increased myometrial vascularity on color Doppler ultrasound. 35 (26%) patients had myometrial cysts (15 superficial and 20 deep). Coexisting uterine fibroids were noticed in 40 (30.3%) patients and 20 (15.5%) patients had adnexal masses. 17 (12.8%) patients had intra- and extra-parenchymal type of pelvic congestion syndrome. Conclusions: Heterogeneous myometrium with striation and posterior shadowing, loss of endometrial-myometrial interface, asymmetric myometrial thickening, and globular uterus are the most common sonographic features of adenomyosis. Presented data will aid in development of the integrated scoring system for detection and objective assessment of adenomyosis.