OC08.01: Differentiation of uterine pathology by transvaginal elastography: preliminary results

Uterine abnormalities such as myomas, adenomyosis, endometrial polyps and uterine malignancies can have similar B-mode characteristics. The aim of this restrospective study was to evaluate whether elastography in addition to conventional sonography can be used as a potential tool in differentiating uterine pathology. Conventional B-mode sonography with color Doppler was followed by elastography in a group of patients with various gynecological problems. We used the Accuvix V20 (Medison) with a 4–9 MHz transvaginal probe. In elastography, the relative stiffness of tissue was displayed with a color coded map. We reviewed the cases where B-mode sonography revealed uterine pathology. The results of the elastography images were subjectively evaluated. Attention was paid to relative stiffness of lesions in contrast to the surrounding myometrium, delineation and size. In a total of 112 patients B-mode sonography revealed one or more uterine fibroids in 48 patients and adenomyosis, endometrial polyps and uterine malignancies in 4, 6 and 4 patients respectively. On elastography myomas appeared stiffer than the surrounding myometrium whereas endometrial polyps appeared softer except in one case where presence of intracavitary fluid made a polyp appear relatively stiff. Most of the myomas where characterized by a clear delineation at the borders of the myoma. Elastography images of suspected adenomyosis showed softer tissue regions in three cases, especially in presence of cystic lesions. In two cases where myomas and adenomyosis where in the same field of view elastography helped to differentiate the two conditions. Relative stiffness was variable in cases of malignancy. Elastography was helpful in distinguishing tumor from blood or necrosis. These preliminary results suggest that transvaginal elastography may be used for differentiation between uterine pathologies. More research is needed to confirm these findings and develop more quantitative methods to assess lesions.