title: Elastography Improves the Diagnostic Accuracy of Sonography in Differentiating Endometrial Polyps and Submucosal Fibroids.
abstract: OBJECTIVE
  To assess whether strain elastography may be used to visualize the different stiffness of endometrial polyps and submucosal fibroids.
  
  
  METHODS
  We conducted a prospective monocentric single-operator study on diagnostic accuracy. Patients who qualified for hysteroscopy because of suspected endometrial polyps and submucosal fibroids were included. Before the procedure, all patients underwent routine sonographic and power Doppler examinations. Additionally, the stiffness of intrauterine lesions was assessed by strain elastography. The enhancement was adjusted to visualize hard myometrium and soft endometrium around the intrauterine lesion. Due to their histologic structure, we assumed that on strain elastography, endometrial polyps should appear as soft lesions, whereas submucosal fibroids should appear as hard lesions. Sonographic, power Doppler, and elastographic findings were verified by pathologic examinations after hysteroscopies. The diagnostic accuracy of sonography, power Doppler imaging, and strain elastography was compared by the McNemar test.
  
  
  RESULTS
  Forty-seven patients were included and underwent hysteroscopy. In 29 cases, endometrial polyps were found, and in 18, submucosal fibroids were found. The diagnostic accuracy rates for B-mode sonography, power Doppler imaging, and strain elastography in distinguishing endometrial polyps and submucosal fibroids were 70.2%, 65.9%, and 89.4%, respectively. The proportion of correct findings was significantly higher for strain elastography than for B-mode sonography (P = .0265) and power Doppler imaging (P = .0153).
  
  
  CONCLUSIONS
  Strain elastography complements sonography in differentiating intrauterine lesions. Strain elastography may be used to visualize the different stiffness of endometrial polyps and submucosal fibroids.
authors.affiliation: Third Department of Gynecology, Medical University of Lublin, Lublin, Poland czuczwar@wp.pl.
authors.forename: Piotr
authors.initials: P
authors.lastname: Czuczwar
authors.affiliation: Third Department of Gynecology, Medical University of Lublin, Lublin, Poland.
authors.forename: Slawomir
authors.initials: S
authors.lastname: Wozniak
authors.affiliation: Third Department of Gynecology, Medical University of Lublin, Lublin, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Szkodziak
authors.affiliation: Department of Obstetrics and Gynecology, Medical University of Silesia, Katowice, Poland.
authors.forename: Marek J
authors.initials: MJ
authors.lastname: Kudla
authors.affiliation: Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Pyra
authors.affiliation: Third Department of Gynecology, Medical University of Lublin, Lublin, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Paszkowski
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D054459:Elasticity Imaging Techniques; D016889:Endometrial Neoplasms / Q000000981:diagnostic imaging*; D004717:Endometrium / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007889:Leiomyoma / Q000000981:diagnostic imaging*; D008875:Middle Aged; D011127:Polyps / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D015203:Reproducibility of Results; D014594:Uterine Neoplasms / Q000000981:diagnostic imaging*
keywords: endometrial polyp; fibroid; gynecologic ultrasound; hysteroscopy; strain elastography