Importance of Transvaginal Elastography in the Diagnosis of Uterine Fibroids and Adenomyosis.
OBJECTIVE
To evaluate normal uterine tissue with special regard to age and the presence of uterine fibroids and adenomyosis with transvaginal elastography.


METHODS
In a prospective study elastographic data of the uterus were obtained in 206 unselected women with transvaginal ultrasound. Women who presented without any uterine pathology in ultrasonography were included in a control group, women with uterine fibroids in a uterine fibroid group, and women with adenomyosis in an adenomyosis group. In the control group strain values were measured at two regions of interest (ROIs) placed one upon the other in the anterior inferior uterine segment during a cycle of compression. The maximum strain ratio (ROI1 / ROI2) was stored as the "age index". In all groups strain values were measured at two ROIs placed side by side in a uterine fibroid (uterine fibroid group) or adenomyosis (adenomyosis group) or healthy homogeneous tissue (control group) and adjacent healthy tissue. Maximum strain ratios (ROI3 / ROI4) were stored as the "lesion index".


RESULTS
The "age index" was significantly negatively correlated with the age of the women (r = -0.49, p < 0.001). The median "lesion indices" were significantly (p < 0.001) different between the uterine fibroid, adenomyosis and control groups. Median "lesion indices" were 2.65, 0.44 and 1.19, respectively.


CONCLUSIONS
The "age index" shows that normal uterine tissue has a certain age-dependent stiffness that increases with age. The "lesion index" allows for the assessment of the presence of a uterine fibroid or adenomyosis and helps to differentiate between both focal findings. Thus the use of elastography in addition to conventional ultrasound could help to diagnose uterine focal lesions and may be useful in preoperative planning.
Department of Obstetrics and Gynecology, University Hospital of Münster, Germany.
M L
ML
Frank
Department of Obstetrics and Gynecology, University Hospital of Münster, Germany.
S D
SD
Schäfer
Department of Obstetrics and Gynecology, University Hospital of Münster, Germany.
M
M
Möllers
Department of Obstetrics and Gynecology, University Hospital of Münster, Germany.
M K
MK
Falkenberg
Department of Obstetrics and Gynecology, University Hospital of Münster, Germany.
J
J
Braun
Department of Obstetrics and Gynecology, University Hospital of Münster, Germany.
U
U
Möllmann
Department of Obstetrics and Gynecology, University Hospital of Münster, Germany.
F
F
Strube
Department of Obstetrics and Gynecology, St. Franziskus-Hospital, Münster, Germany.
A
A
Fruscalzo
Institute of Biostatistics and Clinical Research, University of Münster, Germany.
S
S
Amler
Department of Obstetrics and Gynecology, University Hospital of Münster, Germany.
W
W
Klockenbusch
Department of Obstetrics and Gynecology, University Hospital of Münster, Germany.
R
R
Schmitz
D062788:Adenomyosis / Q000000981:diagnostic imaging*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D054459:Elasticity Imaging Techniques / Q000379:methods*; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D007889:Leiomyoma / Q000000981:diagnostic imaging*; D008875:Middle Aged; D015588:Observer Variation; D011446:Prospective Studies; D012016:Reference Values; D014599:Uterus / Q000000981:diagnostic imaging; D055815:Young Adult