title: Magnetic resonance imaging and transvaginal ultrasonography for the diagnosis of adenomyosis.
abstract: OBJECTIVE
  To compare the diagnostic potential of magnetic resonance imaging (MRI) and transvaginal ultrasonography (TVS) in the diagnosis of adenomyosis.
  
  
  METHODS
  Double blind set-up.
  
  
  METHODS
  University medical school.
  
  
  METHODS
  We studied 106 consecutive premenopausal women who underwent hysterectomy for benign reasons.
  
  
  METHODS
  Transvaginal ultrasonography and MRI were compared with histopathologic examination as the golden standard.
  
  
  METHODS
  Adenomyosis.
  
  
  RESULTS
  Twenty-two (21%) patients had adenomyosis. The sensitivity and specificity were as follows: sensitivity: MRI 0.70 (0.46-0.87) and TVS 0.68 (0.44-0.86) (P=.66); specificity: MRI 0.86 (0.76-0.93) and TVS 0.65 (0.50-0.77) (P=.03). The combination of MRI and TVS was most sensitive (0.89 [0.64-0.98]), but produced the lowest specificity (0.60 [0.44-0.73]). Adenomyosis was not detected by either MRI or TVS at uterine volumes >400 mL. Exclusion of uteri >400 mL from the analysis improved the diagnostic precision of MRI, but not that of TVS. The diagnostic accuracy at MRI was improved by calculating the maximum difference between the thinnest and thickest junctional zone (JZdif) (i.e., > or =5-7 mm).
  
  
  CONCLUSIONS
  Magnetic resonance imaging was superior to TVS for the diagnosis of adenomyosis. Magnetic resonance imaging had a higher specificity than TVS, but their sensitivities were in line. The diagnostic accuracy of MRI, as that of TVS, was at an intermediate level, but the diagnostic accuracy of the former improved by exclusion of uteri >400 mL. The combination of MRI and TVS produced the highest level of accuracy for exclusion of adenomyosis, but the low specificity may necessitate further investigation of positive findings. Measurement of the difference in junctional zone thickness may optimize the diagnosis of adenomyosis at MRI.
authors.affiliation: Department of Gynecology and Obstetrics, Aarhus University and Aarhus University Hospital, Aarhus, Denmark. hjorth@dadlnet.dk
authors.forename: M
authors.initials: M
authors.lastname: Dueholm
authors.forename: E
authors.initials: E
authors.lastname: Lundorf
authors.forename: E S
authors.initials: ES
authors.lastname: Hansen
authors.forename: J S
authors.initials: JS
authors.lastname: Sørensen
authors.forename: S
authors.initials: S
authors.lastname: Ledertoug
authors.forename: F
authors.initials: F
authors.lastname: Olesen
mesh_terms: D000328:Adult; D004311:Double-Blind Method; D004715:Endometriosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D009215:Myometrium / Q000000981:diagnostic imaging / Q000473:pathology; D015588:Observer Variation; D017697:Premenopause; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000379:methods*; D014621:Vagina