P01.01: The use of real‐time elastography in the assessment of uterine disorders

Sono-elastography is an imaging technique added to sonography, measuring tissue strain. The aim of this study is to systematically define specific sono-elastographic characteristics of the myometrium, fibroids and adenomyosis and evaluate the feasibility of sonoelastography in patients suspected of gynecological pathology and to compare it with histology-based and MRI-based diagnoses. We performed a prospective observational cohort study from 2009 to 2011 using a Samsung Medison Accuvix V10 machine. Women included underwent routine transvaginal ultrasound and additional real-time sonographic elastography. The acquirements of elastographic images were standardized. We analyzed elastographic characteristics of myometrium, fibroids and adenomyosis. An independent observer, unaware of clinical, histological or MRI findings evaluated the recorded elastographic images and cine loops. These elastographic-based diagnoses were compared with histology and/or MRI diagnosis. With elastography the uterus is well delineated from the surrounding bowels. The myometrium was uniform in color in 49% of the cases, with a main color of purple or dark blue. Both fibroids and adenomyosis have different elastographic characteristics with different color patterns. In general fibroids were darker and adenomyosis brighter then adjacent myometrium. The agreement between elastography based diagnosis of fibroids and adenomyosis with MRI were excellent, and with histology it was also excellent for fibroids, but less optimal for adenomyosis. Elastography is able to identify clear discriminating characteristics of the uterus, fibroids and adenomyosis.