{"paper_id":"007aa038-9d0d-497e-9400-73aea12554c5","body_text":"Abstract\nPurpose\nTo evaluate the diagnostic performance of Acoustic Radiation Force Impulse (ARFI) elastography in differentiating adenomyosis from uterine leiomyoma and to compare its diagnostic accuracy with magnetic resonance imaging (MRI).\nMethods\nThis prospective study included 164 patients with histopathologically confirmed diagnoses after hysterectomy: adenomyosis (n = 53), leiomyoma (n = 56), and controls (n = 55). All participants underwent preoperative ARFI elastography and MRI. Shear wave elastography (SWE) values were compared among groups, and diagnostic performance was evaluated using receiver operating characteristic (ROC) curve analysis.\nResults\nMean SWE values were significantly higher in the leiomyoma group (3.09 ± 0.78 m/s) than in the adenomyosis (2.80 ± 0.83 m/s; p = 0.040) and control groups (2.57 ± 0.84 m/s; p < 0.001). No significant difference was observed between adenomyosis and controls (p = 0.158). For differentiating leiomyoma from controls, the area under the curve (AUC) was 0.677 (95% CI, 0.581–0.773), with 71.4% sensitivity and 62.8% specificity. For differentiating leiomyoma from adenomyosis, the AUC was 0.619 (95% CI, 0.508–0.730), with 67.1% sensitivity and 59.0% specificity. MRI showed high diagnostic accuracy for both conditions and enabled adenomyosis subtype classification, whereas SWE values did not differ significantly among adenomyosis subtypes.\nConclusion\nARFI elastography demonstrated only modest diagnostic accuracy (AUC 0.619–0.677) in differentiating uterine leiomyoma from normal myometrium and adenomyosis, and failed to distinguish adenomyosis from normal myometrium. Given its limited performance, ARFI elastography cannot be recommended as a standalone diagnostic tool. It may serve as an adjunctive method only in selected settings where MRI is unavailable, but further validation is required before clinical implementation.\nSimilar content being viewed by others\nData Availability\nNo datasets were generated or analysed during the current study.\nAbbreviations\n- ARFI:\n-\nAcoustic Radiation Force Impulse\n- SWE:\n-\nShear Wave Elastography\n- MRI:\n-\nMagnetic Resonance Imaging\n- TVUS:\n-\nTransvaginal Ultrasonography\n- US:\n-\nUltrasonography\n- BMI:\n-\nBody Mass Index\n- ROC:\n-\nReceiver Operating Characteristic\n- AUC:\n-\nArea Under the Curve\n- CI:\n-\nConfidence Interval\n- ROI:\n-\nRegion of Interest\n- JZ:\n-\nJunctional Zone\n- TSE:\n-\nTurbo Spin-Echo\n- DWI:\n-\nDiffusion-Weighted Imaging\n- VIBE:\n-\nVolumetric Interpolated Breath-hold Examination\n- ADC:\n-\nApparent Diffusion Coefficient\n- ANOVA:\n-\nOne-Way Analysis of Variance\n- WBC:\n-\nWhite Blood Cell\n- STROBE:\n-\nStrengthening the Reporting of Observational Studies in Epidemiology\nReferences\nBrosens JJ, Barker FG, de Souza NM. 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Ultrasound Med Biol. 2023;49(3):699–709. https://doi.org/10.1016/j.ultrasmedbio.2022.11.006.\nAcknowledgements\nThe authors acknowledge the use of DeepSeek and ChatGPT for assistance with English language editing, grammar refinement, and literature search during the preparation of this manuscript.\nFunding\nThere is no funding.\nAuthor information\nAuthors and Affiliations\nContributions\nConceptualization, L.H, O.K; methodology, L.H, O.K.; software, L.H, O.K; validation, L.H, O.K; formal analysis, L.H, O.K; investigation, L.H, O.K; resources, L.H, O.K; data curation, L.H, O.K; writing— original draft preparation, L.H, O.K; writing—review and editing, L.H, O.K, visualization, L.H; supervision, L.H, O.K.; All authors have read and agreed to the published version of the manuscript.\nCorresponding author\nEthics declarations\nCompeting Interests\nThe authors declare no competing interests.\nEthical Approval\nThis prospective, single-blind, case-control study was conducted at the Department of Obstetrics and Gynecology, Van Yüzüncü Yıl University Faculty of Medicine, Türkiye, between April 1, 2021, and April 1, 2022. The study was reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement for observational studies. The study protocol was approved by the Clinical Research Ethics Committee of Van Yüzüncü Yıl University (Approval No. 01, March 31, 2021). All study procedures were performed in accordance with the ethical principles of the Declaration of Helsinki. Written informed consent was obtained from all participants after they received detailed information regarding the study.\nConsent for Publication\nNot applicable.\nAdditional information\nPublisher’s Note\nSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.\nRights and permissions\nSpringer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.\nAbout this article\nCite this article\nHacioğlu, L., Karaaslan, O. Acoustic Radiation Force Impulse Elastography for Differentiating Adenomyosis and Uterine Leiomyoma: A Prospective Histopathology-Validated Study with Moderate Diagnostic Performance. Bratisl. Med. J. (2026). https://doi.org/10.1007/s44411-026-00903-9\nReceived:\nRevised:\nAccepted:\nPublished:\nVersion of record:\nDOI: https://doi.org/10.1007/s44411-026-00903-9","source_license":"CC0","license_restricted":false}