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© 2007 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 26:899-908 • 0278-4297

In Vitro Uterine Strain Imaging

Preliminary Results

Maritza A. Hobson, MS, Miklos Z. Kiss, PhD, Tomy Varghese, PhD, Amy M. Sommer, MS, Mark A. Kliewer, MD, James A. Zagzebski, PhD, Timothy J. Hall, PhD, Josephine Harter, MD, Ellen M. Hartenbach, MD and Ernest L. Madsen, PhD

Departments of Medical Physics (M.A.H., M.Z.K., T.V., A.M.S., J.A.Z., T.J.H., E.L.M.), Radiology (M.A.K.), Pathology (J.H.), and Obstetrics and Gynecology (E.M.H.), University of Wisconsin–Madison, Madison, Wisconsin USA. Dr Kiss is currently with Volcano Corp, Cleveland, Ohio USA.

Address correspondence to Maritza A. Hobson, MS, Department of Medical Physics, University of Wisconsin–Madison, 1300 University Ave, 1530 MSC, Madison, WI 53706 USA. E-mail: mahobson{at}gmail.com

Objective. Uterine abnormalities, such as leiomyomas, endometrial polyps, and adenomyosis, are often clinically associated with irregular uterine bleeding. These abnormalities can have similar B-mode characteristics but require different treatment. The objective of this study was to develop diagnostic techniques based on ultrasound strain imaging that would allow in vivo visualization and characterization of endometrial and myometrial uterine abnormalities, enabling physicians to improve diagnosis and treatment. Methods. Ultrasound strain imaging was performed on 29 uteri removed via elective hysterectomy. An ultrasound system with a linear array transducer was used to obtain radio frequency echo data during manual freehand compressions of the tissue. Radio frequency data were post-processed with a 2-dimensional block-matching algorithm to generate strain images. Results. In the uteri involved in this study, there were 19 leiomyomas, 1 case of adenomyosis, and 3 endometrial polyps observed on strain imaging. Leiomyomas appeared stiffer than the surrounding normal myometrium in strain images and were characterized by a slipping artifact at their boundary. Endometrial polyps appeared softer than the normal surrounding myometrium. The average strain contrast in small leiomyomas (<1.5 cm) compared to the myometrium was 1.75 ± 1.14; the strain contrast was 2.50 ± 1.15 in large leiomyomas and 0.40 ± 0.05 in endometrial polyps. Leiomyoma strain contrast results were consistent with modulus contrast values from mechanical testing results. Conclusions. Ultrasound strain imaging can differentiate between endometrial polyps and leiomyomas. More data are necessary to validate these results and to ascertain whether other uterine abnormalities can also be differentiated.

Key Words: adenomyosis • elastography • endometrial polyps • leiomyomas • strain imaging • uterus

Abbreviations: MRI, magnetic resonance imaging • RF, radio frequency • 2D, 2-dimensional

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Copyright © 2007 by the American Institute of Ultrasound in Medicine.