Sonographic findings in patients with adenomyosis: can sonography assist in predicting extent of disease?
OBJECTIVE
We assessed whether specific sonographic characteristics are indicative of the extent of adenomyosis and whether fibroids alter this assessment.


METHODS
Patients' records were evaluated for the diagnosis of adenomyosis determined by hysterectomy and for sonography performed within 2 months of surgery. Seventy-three sonograms were evaluated by sonologists without knowledge of the extent of adenomyosis. Sonographic categories included visualization of the endometrium, presence of a diffuse uterine process, presence of fibroids, and normal findings. Pathologic results included mild, focal, and severe adenomyosis. Histologic and sonographic categories were correlated using the chi-square and Fisher's exact tests.


RESULTS
Forty-six specimens contained mild adenomyosis, 18 contained severe disease, and nine contained focal disease. Forty-one specimens contained fibroids. The endometrium was visualized in 10 cases of severe adenomyosis, seven cases of adenomyoma, and 35 cases of mild disease. Visualization of the endometrium did not relate to the severity of disease (p = 0.6). Of 18 cases of severe disease, 13 sonograms showed a diffuse process. Of nine cases of adenomyomas, no sonograms showed a diffuse process; and of 46 cases of mild disease, nine sonograms showed a diffuse process. A diffuse process was related to the severity of adenomyosis (p < 0.001). When fibroids were present, a diffuse process did not relate to the extent of adenomyosis (p = 0.01).


CONCLUSIONS
In the absence of focal fibroids, a diffuse uterine process seen on sonography relates to the severity of adenomyosis. Fibroids limit the ability to diagnose the severity of adenomyosis. The visualization of the endometrium does not relate to the severity of adenomyosis.
Department of Radiology, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA.
Carol A
CA
Hulka
Deborah A
DA
Hall
Kathleen
K
McCarthy
Joseph
J
Simeone
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004715:Endometriosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D004717:Endometrium / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007889:Leiomyoma / Q000150:complications / Q000000981:diagnostic imaging; D008875:Middle Aged; D014463:Ultrasonography; D014591:Uterine Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D014594:Uterine Neoplasms / Q000150:complications / Q000000981:diagnostic imaging