Journal of Ultrasound in Medicine, Vol 19, Issue 8 529-534, Copyright © 2000 by American Institute of Ultrasound in Medicine
Adenomyosis: sonographic findings and diagnostic accuracy
B. Bromley, T. D. Shipp and B. Benacerraf
Department of Obstetrics and Gynecology, Massachusetts General Hospital, and Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
The purposes of this study were to evaluate the accuracy of pelvic
sonography in identification of adenomyosis and to characterize the most
commonly seen sonographic features. We identified all patients over a 10
year period in whom a prospective diagnosis of adenomyosis was suspected on
the basis of sonographic findings and who had undergone hysterectomy at a
single hospital. Patients were referred for sonography based on standard
indications. Sonographic features used in the diagnosis of adenomyosis
consisted of two or more of the following: a mottled inhomogeneous
myometrial texture, globular appearing uterus, small cystic spaces within
the myometrium, and a "shaggy" indistinct endometrial stripe. Correlation
was made with the pathology report on the hysterectomy specimen. Fifty-one
women met the study criteria. Forty-three of 51 (84.3%) patients
sonographically suspected of having adenomyosis were confirmed as having
adenomyosis by pathologic examination. All patients with adenomyosis had a
mottled heterogeneous appearing uterus, 95% had a globular uterus, 82% had
small myometrial lucent areas, and 82% had an indistinct endometrial
stripe. Eight patients (15.6%) who had been suspected of having adenomyosis
by pelvic sonography did not have adenomyosis reported in the pathology
specimen. Six of these eight (75%) patients had multiple small fibroids,
one had stage IV endometriosis, and one had a normal uterine specimen with
no evidence of pathology. Pelvic sonography provides an accurate diagnosis
of adenomyosis in the majority of cases.
