title: MRI, US or real-time virtual sonography in the evaluation of adenomyosis?
abstract: OBJECTIVE
  Real-time virtual sonography (RVS) allows displaying and synchronizing real-time US and multiplanar reconstruction of MRI images. The purpose of this study was to evaluate the feasibility and ability of RVS to assess adenomyosis since literature shows US itself has a reduced diagnostic accuracy compared to MRI.
  
  
  METHODS
  This study was conducted over a 4-month period (March-June 2015). We enrolled in the study 52 women with clinical symptoms of dysmenorrhea, methrorragia and infertility. Every patient underwent an endovaginal US examination, followed by a 3T MRI exam and a RVS exam (Hitachi HI Vision Ascendus). The MRI image dataset acquired at the time of the examination was loaded into the fusion system and displayed together with the US images. Both sets of images were then manually synchronized and images were registered using multiple plane MR imaging. Radiologist was asked to report all three examinations separately.
  
  
  RESULTS
  On a total of 52 patients, on standard endovaginal US, adenomyosis was detected in 27 cases: of these, 21 presented diffuse adenomyosis, and 6 cases focal form of adenomyosis. MRI detected adenomyosis in 30 cases: 22 of these appeared as diffuse form and 8 as focal form, such as adenomyoma and adenomyotic cyst, thus resulting in 3 misdiagnosed cases on US. RVS confirmed all 22 cases of diffuse adenomyosis and all 8 cases of focal adenomyosis.
  
  
  CONCLUSIONS
  Thanks to information from both US and MRI, fusion imaging allows better identification of adenomyosis and could improve the performance of ultrasound operator thus to implement the contribution of TVUS in daily practice.
authors.affiliation: Department of Radiological Oncological and Anatomopathological Sciences, Umberto I Hospital, "Sapienza" University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Vinci
authors.affiliation: Department of Radiological Oncological and Anatomopathological Sciences, Umberto I Hospital, "Sapienza" University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Saldari
authors.affiliation: Department of Radiological Oncological and Anatomopathological Sciences, Umberto I Hospital, "Sapienza" University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
authors.forename: Maria Eleonora
authors.initials: ME
authors.lastname: Sergi
authors.affiliation: Department of Radiological Oncological and Anatomopathological Sciences, Umberto I Hospital, "Sapienza" University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Bernardo
authors.affiliation: Department of Obstetrics and Gynecology, University Roma Tor Vergata, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Rizzo
authors.affiliation: Department of Obstetrics and Gynecology, Umberto I Hospital, "Sapienza" University of Rome, Viale Regina Elena 324, 00168, Rome, Italy.
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Porpora
authors.affiliation: Department of Radiological Oncological and Anatomopathological Sciences, Umberto I Hospital, "Sapienza" University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Catalano
authors.affiliation: Department of Radiological Oncological and Anatomopathological Sciences, Umberto I Hospital, "Sapienza" University of Rome, Viale Regina Elena 324, 00161, Rome, Italy. lucia.manganaro@uniroma1.it.
authors.forename: Lucia
authors.initials: L
authors.lastname: Manganaro
mesh_terms: D062788:Adenomyosis / Q000000981:diagnostic imaging*; D003199:Computer Systems; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D011446:Prospective Studies; D014463:Ultrasonography / Q000379:methods; D014584:User-Computer Interface
keywords: Adenomyosis; MRI; RVS