OC75: Differential diagnosis of uterine myomas and adenomyosis by color Doppler (CD) and contrast‐enhanced ultrasound (CEU)

To compare CEU and CD findings in cases where a diagnosis of uterine adenomyosis was suspected on conventional transvaginal ultrasound (TVUS). In 64 patients uterine adenomyosis was suspected at TVUS based on the following findings: asymmetrical thickening of the uterine wall, myometrial dyshomogeneity with fluid-filled areas, broadening of the endo-myometrial junction. All cases were evaluated by CD and CEU (4.8 ml SonoVue, Bracco, Italy). CD was performed to assess the presence of diffuse intralesional or ‘basket’ vascularisation of the lesions. Subsequently, CEU assessed the pattern of vascularisation in the early ( 1.5 s) arterial phase, as well as wash-in and wash-out times. Follow up was available in 57 cases where the final diagnosis was obtained with a combination of magnetic resonance imaging (52/57), hysterectomy (18/57) and or surgical resection (13/57). There were 18 confirmed cases of adenomyosis, 35 confirmed cases of fibroids and 4 false positives. The pattern of vascularisation seen on CEU and CD is shown in the Table. The wash-in time in CEU was significantly shorter in adenomyosis than in fibroids, with a mean difference of 3.2 seconds but with a wide overlap between the two populations. CEU appears superior to CD in the diagnosis of adenomyosis suspected at conventional TVUS. The presence of ‘basket’ vascularisation has a 100% negative predictive value and, if present, allows the differential diagnosis. Early phase, but not late phase, CEU improves the detection of such finding.