Sonographic features of adenomyosis

Abstract

The association between adenomyosis, assisted reproductive technology outcomes, and pregnancy complications is well established. The purpose of this retrospective study was to assess the most common sonographic features of adenomyosis and prevalence of coexisting pathology. Systematic retrospective assessment of 828 transvaginal color Doppler ultrasound exams was performed by a single evaluator using ViewPoint reporting system. About 132 patients with abnormal uterine bleeding and sonographic signs of adenomyosis were identified. The average age was 40.6 years. The average gravidity and parity were 2.8 and 2.2 respectively. In addition to abnormal uterine bleeding observed in all 132 patients, pelvic pain and dysmenorrhea were encountered in 64 (48%) patients respectively. Eight patients (6.1%) were infertile. The uterus was anteverted in 103 (78%), and retroverted in 29 (22%) of patients. The most common sonographic findings associated with adenomyosis were heterogeneous myometrium with striation and posterior shadowing and loss of endometrial–myometrial interface observed in 111 (84%) patients. Asymmetrical myometrial thickening was detected in 106 (80.4%), and globular uterus in 100 (75.5%) patients. Seventy-six (57.5%) patients had increased myometrial vascularity on color Doppler US. Thirty-five (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. Seventeen (12.8%) patients had intra- and extraparenchymal type of pelvic congestion syndrome. Heterogeneous myometrium with striation and posterior shadowing, loss of endometrial–myometrial interface, asymmetrical myometrial thickening, and globular uterus were 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.