Acoustic Radiation Force Impulse Elastography for Differentiating Adenomyosis and Uterine Leiomyoma: A Prospective Histopathology-Validated Study with Moderate Diagnostic Performance

Latif HACIOĞLU, Onur Karaaslan
Bratislava Medical Journal · 2026 · doi:10.1007/s44411-026-00903-9 · W7221762399
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This prospective study found that acoustic radiation force impulse elastography has only modest diagnostic performance for differentiating adenomyosis from uterine leiomyoma and cannot distinguish adenomyosis from normal myometrium.

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This prospective study evaluated the diagnostic performance of Acoustic Radiation Force Impulse elastography in differentiating adenomyosis from uterine leiomyoma and normal myometrium. The researchers analyzed preoperative data from 164 patients who underwent hysterectomy, comparing shear wave elastography values against histopathological confirmation and magnetic resonance imaging results. Although leiomyomas exhibited significantly higher stiffness than adenomyosis, ARFI elastography demonstrated only modest accuracy for distinguishing these conditions and failed to differentiate adenomyosis from normal tissue. Relevance to endometriosis: listed as one indication for GnRH antagonists, though the paper's main focus is uterine fibroids.

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Abstract

Purpose To 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). Methods This 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. Results Mean 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. Conclusion ARFI 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.
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Abstract

Purpose To 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).

Methods

This 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.

Results

Mean 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.

Conclusion

ARFI 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. Similar content being viewed by others Data Availability No datasets were generated or analysed during the current study. Abbreviations - ARFI: - Acoustic Radiation Force Impulse - SWE: - Shear Wave Elastography - MRI: - Magnetic Resonance Imaging - TVUS: - Transvaginal Ultrasonography - US: - Ultrasonography - BMI: - Body Mass Index - ROC: - Receiver Operating Characteristic - AUC: - Area Under the Curve - CI: - Confidence Interval - ROI: - Region of Interest - JZ: - Junctional Zone - TSE: - Turbo Spin-Echo - DWI: - Diffusion-Weighted Imaging - VIBE: - Volumetric Interpolated Breath-hold Examination - ADC: - Apparent Diffusion Coefficient - ANOVA: - One-Way Analysis of Variance - WBC: - White Blood Cell - STROBE: - Strengthening the Reporting of Observational Studies in Epidemiology

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Acknowledgements

The 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. Funding There is no funding. Author information Authors and Affiliations Contributions Conceptualization, 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. Corresponding author Ethics declarations Competing Interests The authors declare no competing interests. Ethical Approval This 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. Consent for Publication Not applicable. Additional information Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions Springer 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. About this article Cite this article Hacioğlu, 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 Received: Revised: Accepted: Published: Version of record: DOI: https://doi.org/10.1007/s44411-026-00903-9

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