Transvaginale Ultraschalldiagnostik der Adenomyose

Zusammenfassung Die Adenomyose ist eine häufige gutartige Erkrankung der Gebärmutter, die bei den meisten betroffenen Frauen Symptome wie Dysmenorrhö, Dyspareunie, Unterbauchschmerzen und Blutungsstörungen verursachen kann. Sie hat einen ungünstigen Einfluss auf die Fertilität, führt zu höheren Abortraten, zu niedrigeren Erfolgsraten bei künstlicher Befruchtung und kann geburtshilfliche Komplikationen wie vorzeitigen Blasensprung, Frühgeburtlichkeit, Plazentationsstörungen, Uterusruptur sowie fetale Wachstumsretardierungen verursachen. Die genaue Inzidenz der Adenomyose ist unklar, und die vorhandenen Daten hierzu stammen aus Kohortenstudien, in denen die Diagnose mittels Hysterektomie gesichert wurde. Die Adenomyose tritt aber von der Adoleszenz bis zur Postmenopause auf. Wegen fehlender zuverlässiger Methoden der organerhaltenden histologischen Sicherung wird die Diagnose anhand bildgebender Verfahren gestellt. Liegen transvaginale Sonographie und Magnetresonanztomographie in den Händen geübter UntersucherInnen, sind sie hinsichtlich der diagnostischen Zuverlässigkeit vergleichbar. Die Ultraschalldiagnostik, insbesondere die 2‑dimensionale transvaginale Sonographie, ist aufgrund der besseren Verfügbarkeit und der geringeren Kosten die diagnostische Methode der ersten Wahl. Die in der Literatur beschriebenen sonographisch sichtbaren Veränderungen des Uterus werden in direkte und indirekte Zeichen unterteilt. Die Zuverlässigkeit der Befundung ist vom Ausbildungsstand der UntersucherInnen und von der technischen Qualität des Ultraschallgeräts abhängig. Abstract Adenomyosis is a frequent benign uterine condition, which can cause symptoms, such as dysmenorrhea, dyspareunia, lower abdominal pain and bleeding disorders in most affected women. Adenomyosis is related to a negative impact on fertility with higher abortion rates and lower success rates in assisted reproduction and it can cause obstetrical complications, such as premature rupture of membranes, premature birth, placentation failure, uterine rupture and fetal growth retardation. The exact incidence of adenomyosis remains uncertain as the available data are based on cohort studies in which the diagnosis was confirmed by hysterectomy; however, adenomyosis can occur from adolescence up to the postmenopausal epoch. Due to the lack of reliable methods of obtaining histological samples without damaging organs, the diagnosis is made based on imaging procedures. In the hands of experienced investigators magnetic resonance imaging (MRI) and transvaginal ultrasound are comparable with respect to the diagnostic reliability. Due to its relatively low cost and accessibility, ultrasound diagnostics and in particular two-dimensional transvaginal sonography represent the first-line imaging approach. The sonographically visible alterations to the uterus described in the literature are divided into direct and indirect signs. The reliability of the interpretation of the results depends on the individual experience of the investigator and the technical quality of the ultrasound scanner. Similar content being viewed by others Literatur Krentel H, Cezar C, Becker S, Di Spiezio Sardo A, Tanos V, Wallwiener M, De Wilde RL (2017) From clinical symptoms to MR imaging: diagnostic steps in adenomyosis. Biomed Res Int 2017:1514029 Ferrero S, Camerini G, Menada MV, Biscaldi E, Ragni N, Remorgida V (2009) Uterine adenomyosis in persistence of dysmenorrhea after surgical excision of pelvic endometriosis and colorectal resection. 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Krentel, A. Constantin, A. Naem, K. Otto, D. Andrikos und R.L. De Wilde geben an, dass kein Interessenkonflikt besteht. Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien. Additional information Redaktion Annette Bachmann, Frankfurt Ludwig Kiesel, Münster Petra Stute, Bern Hinweis des Verlags Der Verlag bleibt in Hinblick auf geografische Zuordnungen und Gebietsbezeichnungen in veröffentlichten Karten und Institutsadressen neutral. QR-Code scannen & Beitrag online lesen Rights and permissions About this article Cite this article Krentel, H., Constantin, A., Naem, A. et al. Transvaginale Ultraschalldiagnostik der Adenomyose. Gynäkologische Endokrinologie 22, 209–215 (2024). https://doi.org/10.1007/s10304-024-00579-w Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s10304-024-00579-w Schlüsselwörter - Zweidimensionaler transvaginaler Ultraschall - Transvaginaler Ultraschall/Untersuchererfahrung - Dysmenorrhö - Endometriose - Blutungsstörungen