OC7.05: Increasing detection of adenomyosis on ultrasound: imaging characteristics on transvaginal ultrasound using MRI as the gold standard

Identify imaging features of adenomyosis on transvaginal ultrasound (TVS) using MRI as gold standard. 3-year database search to identify women who had TVS & MRI of the pelvis within 6 months of each other. MR images reviewed by an experienced MR radiologist to evaluate for adenomyosis (focal/diffuse junctional zone thickening, at least 12 mm with/without myometrial cysts). TVS reviewed by experienced sonologist blinded to MR findings, specifically to look for features of adenomyosis: indistinct endometrial-myometrial junction, myometrial cysts, asymmetric myometrial thickening, mass effect, striated shadowing (alternating bands of increased and decreased echogenicity in myometrium) and thickened inner hypoechoic myometrium. Findings at TVS and MRI were compared to original reads. Statistical analysis was performed using Fisher's Exact test and logistic regression ROC analysis. TVS and MRI of 80 women, 34–68 years (mean 48) reviewed. 22/80 excluded because of large central fibroids (n = 17), nondiagnostic image quality (n = 5). 47/58 patients were premenopausal and 11/58 were post-menopausal. 45/58 had adenomyosis on MRI. 33/58 had adenomyosis diagnosed on TVS: sensitivity 73%, specificity 46% compared to original TVS reading: sensitivity 40%, specificity 69%. The sensitivity and specificity of individual TVS characteristics were: indistinct endometrial-myometrial junction 38%, 77%, striated shadowing 44%, 100%, thickened hypoechoic inner myometrium 40%, 77%, mass effect 18%, 100% and asymmetric myometrial thickness: 33%, 85% respectively. Using ROC analysis with full loaded formula combining all characteristics the area under the ROC curve was 0.89. There was mild positive correlation between detection of adenomyosis on TV and junctional zone thickness at MRI (r = 0.56, p < 0.01). Detection of adenomyosis by TVS may be improved by increased awareness of the entity and recognition of its specific sonographic imaging characteristics.