An Alternative Diagnostic Tool for Women with Adenomyosis

A simple ultrasound technique improves the diagnostic capability of transvaginal ultrasound in detecting adenomyosis, a common benign condition of the uterus that causes dysmenorrhea, abnormal vaginal bleeding, and pelvic pain.

Researchers at Thomas Jefferson University Hospital (Philadelphia, PA, USA) conducted a study to evaluate sonohysterography (SHG), commonly used to evaluate the uterine cavity, in 26 women who underwent both SHG and MRI of the pelvis and in whom either modality suggested adenomyosis. Of these 26 women, 23 (88%) had SHG findings suggestive of adenomyosis. Three remaining women (12%) had adenomyosis identified on MRI performed after SHG. MRI confirmed adenomyosis in 22 out of 23 patients (96%). The study was published in the April 2009 issue of the American Journal of Roentgenology (AJR).

"Patients often present with symptoms of abnormal bleeding, pelvic pain, and infertility which may be due to a uterine fibroid, a polyp, tumor or adenomyosis. MR imaging is expensive and is not always available as a first line investigation to evaluate abnormal bleeding," said lead author Sachit Verma, M.D. "In addition it is difficult to distinguish lesions in the uterus (myometrium and endometrium) using transvaginal ultrasound alone. SHG then has a role to play in managing these patients."

SHG helps detect the presence of ill-defined areas of fluid intravasation--known as fluid containing tracks--extending from the uterine cavity into the myometrium, called "myometrial cracks" on SHG. The researchers explained that myometrial cracks were difficult to characterize on standard transvaginal ultrasound, but become conspicuous in SHG as saline seeps through them. The researchers detected these cracks in 26% of the cases.

"Knowledge of 'myometrial cracks' will decrease the errors in interpretation and improve patient care so that specific treatment can be instituted. This additional information for the referring physician can possibly decrease the number of endometrial biopsies - reducing costs in patient management - in cases where SHG shows no uterine abnormality and adenomyosis is the sole cause of abnormal bleeding," concluded Dr. Verma.

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Thomas Jefferson University Hospital