ULTRASOUND AND THE DIAGNOSIS OF ADENOMYOSIS
SUMMARY OF POSTER INFORMATION U.K.R.C. 2004
ULTRASOUND AND THE DIAGNOSIS OF ADENOMYOSIS:
A RETROSPECTIVE STUDY
Royal Glamorgan Hospital
Lynne Francis (Superintendent Radiographer)
Dr. C. J. Davies (Consultant Radiologist)
WHAT IS ADENOMYOSIS?
A common benign condition that often co-exists with endometriosis and fibroids, often described as endometriosis within the uterus itself
Endometrial tissue exists within the muscle of the uterus. During menstruation this degenerates and the blood cannot escape the uterine muscle causing pain; some blood may finally escape resulting in abnormal p.v. spotting
WHAT CAN CAUSE ADENOMYOSIS?
Previous childbirth
Previous termination of pregnancy
Previous caesarean section
Previous tubal ligation sterilisation
Uterine trauma (such that endometrial tissue can be relocated from the uterine lining e.g. an over zealous D&C)
WHAT ARE THE CLINICAL FEATURES?
Uterine enlargement
Heavy periods, often with clots
Cyclical pain, cramping or knife-like
More common in the multiparous over 35 age group
More common in the higher socio-economic group (more likely to visit G.P? more caesarean sections?)
WHAT ARE THE ULTRASOUND APPEARANCES?
MAY BE NORMAL
Diffuse uterine enlargement with no alteration in echo-texture or uterine contour, often reported as a “bulky uterus”
Asymmetrically thickened uterus, usually posteriorly
Poorly defined focal area of hypoechoic or hyperechoic texture within the myometrium, representing a focal adenomyoma (can be multiple)
Cystic hyperplasia of the endometrium
Myometrial cysts
SAMPLE INVESTIGATED:
60 post-hysterectomy specimens with confirmed adenomyosis over a period of 3 years, 28 of these patients had undergone recent ultrasound scans prior to surgery. These reports and images were reviewed.
WE HAD 28 ULTRASOUND REPORTS AND NONE HAD INDICATED ADENOMYOSIS AS A POSSIBLE DIAGNOSIS BASED ON THE ULTRASOUND FINDINGS
KEY POINT:
10 OF THESE REPORTS HAD INDICATED THAT THE UTERUS WAS SEEN TO BE “BULKY” OR “DIFFUSELY ENLARGED” WITH NO EXLANATION OR SUGGESTION OF POSSIBLE DIAGNOSIS OFFERED
WHY IS THE CORRECT DIAGNOSIS IMPORTANT?
This condition is frequently under-diagnosed resulting in an erroneous clinical diagnosis of dysfunctional bleeding
This group of women may then be treated with hormone therapy or other equally ineffective measures with a failure to respond
CONCLUSION AND RECOMMENDATIONS
This study confirmed a lack of awareness of this common condition and its ultrasound appearance
Overall understanding of adenomyosis by both radiologists and sonographers has been increased
Consider adenomyosis as a possible diagnosis in the evaluation of any woman with abnormal bleeding in the right age group, so that the correct treatment path can be followed.
To recommend M.R.I. (the gold standard) in the correct clinical setting, it is important to be aware of and recognise the ultrasound appearances of this condition and to request M.R.I. investigations only when appropriate.
To repeat this study in 18 months and reassess our accuracy in diagnosing adenomyosis. There could only be room for improvement.
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