OP16.04: Adenomyosis: three dimensional sonographic findings of the junctional zone in infertile patients

The uterine junctional zone (JZ) seems to play an integral part in the implantation process. The coronal section of the uterus obtained by three dimensional (3D) transvaginal sonographic (TVS) permits an accurate evaluation of the JZ. An alteration in the JZ shows a high diagnostic accuracy for adenomyosis. The aim of this study is to assess the 3D TVS detectable morphological alterations of the JZ in infertile patients. We retrospectively evaluated JZ on the uterine coronal section obtained by 3D volume acquisition in infertile patients scheduled for HyCoSy. All patients underwent a HyCoSy, in the early proliferative phase, followed by a detailed TVS scan and 3D volume acquisition of the entire uterus. On the volume and multiplanar planes we evaluated: uterine diameters and volume, endometrial thickness, min JZ and max JZ thickness, alteration of the JZ, presence of myometrial cystic areas, asymmetry of myometrial wall, presence of myometrial hyperechoic areas and striations. A JZmax > 5 mm, or a JZmax-JZmin > 5, and presence of other TVS signs, were considered diagnostic for adenomyosis and were correlated with the cause of infertility when known. Of the 123 infertile patients included in this study 81 had primary and 42 secondary infertility. 48 patients had a JZmax > 5 mm with a mean age of 37.8 ± 4.2 yrs significantly higher than those with JZmax ⩽ 5 mm (35.6 ± 3.2 yrs). Patients with secondary infertility showed mean values of JZmax (6.4 ± 1.1 vs. 5.2 ± 1.2 mm) and JZmax-JZmin (3.8 ± 0.9 vs. 2.9 ± 1.2 mm) which was significantly greater than in patients with primary infertility. Other myometrial sonographic features of adenomyosis were found in 27 (56%) of 48 patients with JZ max > 5 mm and in only 3 of 75 (4%) with JZ max ⩽ 5 mm. The coronal section of the uterus obtained by 3D TVS permits an accurate evaluation of the JZ on the coronal section. Non invasive assessment of JZ prior to conception may turn out to be useful in identifying those women affected by initial grade of adenomyosis.