Diagnostic Role of Transvaginal Sonography and Magnetic Resonance Imaging in Adenomyosis of the Uterus and its Correlation with Histopathology.

IF 1.2 Q3 OBSTETRICS & GYNECOLOGY Journal of Mid-life Health Pub Date : 2023-01-01 Epub Date: 2023-07-07 DOI:10.4103/jmh.jmh_230_22

Shivi Jain, Kamlesh Kumar, Ram Chandra Shukla, Madhu Jain

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Abstract

Background and objective: The prevalence of adenomyosis of the uterus varies from 5% to 70%, and there is no clear consensus on its imaging diagnostic criteria. The objective of this study was to evaluate the role of transvaginal sonography (TVS), combined TVS and color Doppler (TVS-CD), and magnetic resonance imaging (MRI) in the diagnosis of adenomyosis.

Materials and methods: This was a tertiary care hospital-based prospective study, in which 365 clinically suspected cases of adenomyosis were enrolled. All three types of imaging (TVS, TVS-CD, and MRI) were done in 233/365 patients, followed by hysterectomy in 50. Imaging features were correlated with the histopathological examination (HPE), which was taken as the gold standard for the diagnosis. The diagnostic performance of each imaging modality was assessed.

Results: Among patients who underwent hysterectomy, 36/50 (72%) had adenomyosis on HPE, with or without associated benign gynecological abnormalities. Sensitivity, specificity, positive predictive value (PPV), negative PV (NPV), and diagnostic accuracy (DA) of MRI were higher than that of TVS-CD (91.67% vs. 77.78%, 85.71% vs. 78.57%, 94.29% vs. 90.32%, 80% vs. 57.89%, and 90% vs. 78%, respectively). TVS alone had lower diagnostic performance (specificity: 64.29%, PPV 84.85%, NPV 52.94%, and DA74%) than TVS-CD, but equal sensitivity (77.78%). Heterogeneous myometrium was the most sensitive (80.56%), while myometrial cyst was the most specific (92.86%) TVS feature. The maximum junctional zone thickness ≥12 mm was the most sensitive (97.22%), while the hyperintense myometrial focus was the most specific (100%) MRI feature.

Conclusion: TVS-CD should be used as an initial diagnostic imaging modality in clinically suspected cases of adenomyosis; however, MRI due to better diagnostic efficacy should be the imaging modality of choice before subjecting such patients to hysterectomy.

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经阴道超声和磁共振成像对子宫腺肌病的诊断作用及其与组织病理学的相关性。

背景与目的：子宫腺肌症的患病率在5%-70%之间，其影像学诊断标准尚未达成明确共识。本研究的目的是评估经阴道超声（TVS）、TVS和彩色多普勒（TVS-CD）以及磁共振成像（MRI）在子宫腺肌病诊断中的作用。材料和方法：这是一项基于三级护理医院的前瞻性研究，纳入了365例临床疑似子宫腺肌病病例。所有三种类型的成像（TVS、TVS-CD和MRI）在233/365名患者中进行，然后在50名患者中子宫切除。影像学特征与组织病理学检查（HPE）相关，后者被视为诊断的金标准。评估了每种成像模式的诊断性能。结果：在接受子宫切除术的患者中，36/50（72%）患有HPE子宫腺肌症，伴有或不伴有相关的良性妇科异常。MRI的敏感性、特异性、阳性预测值（PPV）、阴性PV（NPV）和诊断准确性（DA）均高于TVS-CD（分别为91.67%对77.78%、85.71%对78.57%、94.29%对90.32%、80%对57.89%和90%对78%）。TVS单独的诊断性能（特异性：64.29%，PPV 84.85%，NPV 52.94%，DA74%）低于TVS-CD，但敏感性相同（77.78%）。不均匀性子宫肌层是最敏感的（80.56%），而肌层囊肿是最特异的（92.86%）TVS特征。最大交界区厚度≥12mm是最敏感的（97.22%），而高信号肌层病灶是最特异的（100%）MRI特征。结论：TVS-CD应作为临床可疑子宫腺肌病的初步诊断影像学模式；然而，在对此类患者进行子宫切除术之前，MRI由于更好的诊断效果应该是首选的成像方式。

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来源期刊

Journal of Mid-life Health Social Sciences-Health (social science)

CiteScore

1.70

自引率

9.10%

发文量

审稿时长

43 weeks

期刊介绍： Journal of mid-life health is the official journal of the Indian Menopause society published Quarterly in January, April, July and October. It is peer reviewed, scientific journal of mid-life health and its problems. It includes all aspects of mid-life health, preventive as well as curative. The journal publishes on subjects such as gynecology, neurology, geriatrics, psychiatry, endocrinology, urology, andrology, psychology, healthy ageing, cardiovascular health, bone health, quality of life etc. as relevant of men and women in their midlife. The Journal provides a visible platform to the researchers as well as clinicians to publish their experiences in this area thereby helping in the promotion of mid-life health leading to healthy ageing, growing need due to increasing life expectancy. The Editorial team has maintained high standards and published original research papers, case reports and review articles from the best of the best contributors both national & international, consistently so that now, it has become a great tool in the hands of menopause practitioners.