OC152: Uterine adenomyosis at 3D transvaginal sonography by VCI analysis

To evaluate the accuracy of 3D transvaginal sonography (3D-TVS) in the diagnosis of deep uterine adenomyosis in symptomatic premenopausal women. Twenty-four consecutive premenopausal patients with abnormal uterine bleeding, inhomogeneous and/or thickened myometrium at 2D-TVS, and the diagnosis of deep uterine adenomyosis at 3D-TVS (GE Voluson 730-pro unit, wide-band 3–9-MHz transducer) were prospectively enrolled. Compound resolution imaging (CRI) and speckle reduction imaging (SRI) technologies were used to optimize images before volume acquisition by enhancing contrast resolution and reducing artifacts and speckle. Volume contrast imaging (VCI) analysis of the stored 3D multiplanar examination was considered for the evaluation of the myometrium in 2-mm slices. In addition to standard criteria we included the discontinuation of the archimetrial layer of the myometrium by infiltrating adenomysosis. Pathological reports of surgically removed uteri and/or at magnetic resonance imaging (MRI) reports were considered the gold standard. Demographic and sonographic data were recorded. Median age was 44 (IR, 40–48) years. Seven patients underwent MRI because of concomitant ovarian and deep infiltrating endometriosis. Seventeen patients underwent hysterectomy for final surgical treatment of symptoms. Pathological and MRI reports confirmed deep uterine adenomyosis in all patients. Diffuse, anterior and posterior deep uterine adenomyosis was observed in 13 (54%), six (25%) and five (21%) patients, respectively. The diagnosis of deep uterine adenomyosis at 3D-TVS by VCI analysis was correct in all cases. This was probably due to the enhancement of tissue echogenic pattern by adding up the high-resolution information from single ultrathin sonographic planes into 2-mm slices. These preliminary results, if confirmed in a larger study, could define 3D-TVS VCI as a possible standard for the diagnosis of deep uterine adenomyosis.