Role of 3D Ultrasound and Doppler in Differentiating Clinically Suspected Cases of Leiomyoma and Adenomyosis of Uterus

Kaveri Sharma, Manash Kumar Bora, B P Venkatesh, Partho Barman, Sumit Kumar Roy, Usha Jayagurunathan, Eswaramoorthy Sellamuthu, Fazil Moidu
Journal of clinical and diagnostic research : JCDR · 2015 · vol. 9(4) , pp. QC08–12 · doi:10.7860/jcdr/2015/12240.5846 · PMID:26023602 · PMC4437118 · W2164541861
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3D ultrasound and Doppler parameters, including peripheral versus central vascularity and blood flow impedance indices, effectively differentiate uterine leiomyoma from adenomyosis with high sensitivity and specificity.

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This study enrolled 100 reproductive-age patients with symptoms such as abnormal uterine bleeding (with or without dysmenorrhea), lump abdomen, chronic pelvic pain, or dyspareunia who were clinically suspected to have uterine leiomyoma and/or adenomyosis. Using transvaginal and transabdominal 3D ultrasound plus color and spectral Doppler in the follicular phase, the authors assessed lesion morphology, vascularity patterns, and Doppler-derived pulsatility index (PI), resistive index (RI), and Vmax, then correlated radiologic diagnoses with operative and histopathological findings. For leiomyoma, Doppler and morphological criteria yielded high diagnostic performance (reported sensitivity 93.4%, specificity 95.6%, PPV 97.6%, NPV 88.6%), while adenomyosis showed sensitivity 95.6% and specificity 93.4% (PPV 88.6%, NPV 97.6%); co-existence was correctly diagnosed in 8 of 66 cases. The authors note potential bias control by selecting the follicular phase, and inclusion was limited to patients chosen for operative treatment, which may restrict generalizability. Relevance to endometriosis: adenomyosis is closely related to endometriosis as a disorder of uterine endometrial tissue invasion, but this paper focuses on differentiating adenomyosis from leiomyoma using 3D ultrasound and Doppler in clinically suspected uterine cases.

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Abstract

INTRODUCTION: Adenomyosis and Leiomyoma are common disorders affecting females in their reproductive age. They mimic each other in clinical presentation. Due to similarities in clinical symptoms and signs, missing one diagnosis in favour of the other is not very uncommon. Accurate diagnosis of these two conditions is important for their management. In this study we evaluated role of 3D Ultrasound and Doppler in differentiating clinically suspected cases of leiomyoma and adenomyosis of uterus. MATERIALS AND METHODS: A total of 100 patients with symptoms of abnormal uterine bleeding (with or without dysmenorrhoea), lump abdomen, chronic pelvic pain or dysparaunia who were clinically diagnosed as leiomyoma of uterus and/or adenomyosis were enrolled in to the study. These patients underwent transvaginal sonography (TVS), trans abdominal sonography (TAS) along with color and spectral Doppler sonography. Scanning was done in follicular phase of the menstrual cycle to avoid bias due high vascularity of endometrium in secretory phase. The morphology of the lesion, its vascularity, and Pulsality Index (PI), Resistive Index (RI) and Vmax (maximum velocity) were measured. Only those patients who were chosen for operative treatment were included in the study. Radiological diagnosis was then correlated with intra-operative and histopathological diagnosis. RESULTS: On imaging, while using morphological criteria and Doppler for diagnosing leiomyoma, it was found that "peripheral vascularity" was seen in 52 (89%) cases, which was the highest. Similarly while diagnosing adenomyosis it was, the criteria "central vascularity" was seen in 28 cases (93%) and "ill defined junctional zone in 3D ultrasound" was seen in 26 cases (86%), which was also observed to be highest. With the cut off values taken for PI,RI and Vmax, diagnosis of leiomyoma was found to be 93.4% sensitive, 95.6% specific and with a positive predictive value of 97.6% and negative predictive value of 88.6%. Diagnosis of adenomyosis showed a sensitivity of 95.6%, specificity of 93.4% and a positive predictive value of 88.6% and negative predictive value of 97.6%. Imaging dignosed the co-existence of both the conditions correctly in 8 (66%) cases. CONCLUSION: The parameters of blood flow impedance (that is PI, RI, and Vmax) of arteries within or around the uterine lesions revealed a consistent and significant difference between leiomyoma and adenomyosis. So apart from morphological criteria used in 3D TAS and TVS, aid of color Doppler can more accurately differentiate and diagnose these conditions.
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Introduction

Adenomyosis and Leiomyoma are common disorders affecting females in their reproductive age. They mimic each other in clinical presentation. Due to similarities in clinical symptoms and signs, missing one diagnosis in favour of the other is not very uncommon. Accurate diagnosis of these two conditions is important for their management. In this study we evaluated role of 3D Ultrasound and Doppler in differentiating clinically suspected cases of leiomyoma and adenomyosis of uterus.

Materials and methods

A total of 100 patients with symptoms of abnormal uterine bleeding (with or without dysmenorrhoea), lump abdomen, chronic pelvic pain or dysparaunia who were clinically diagnosed as leiomyoma of uterus and/or adenomyosis were enrolled in to the study. These patients underwent transvaginal sonography (TVS), trans abdominal sonography (TAS) along with color and spectral Doppler sonography. Scanning was done in follicular phase of the menstrual cycle to avoid bias due high vascularity of endometrium in secretory phase. The morphology of the lesion, its vascularity, and Pulsality Index (PI), Resistive Index (RI) and Vmax (maximum velocity) were measured. Only those patients who were chosen for operative treatment were included in the study. Radiological diagnosis was then correlated with intra-operative and histopathological diagnosis.

Results

On imaging, while using morphological criteria and Doppler for diagnosing leiomyoma, it was found that “peripheral vascularity” was seen in 52 (89%) cases, which was the highest. Similarly while diagnosing adenomyosis it was, the criteria “central vascularity” was seen in 28 cases (93%) and “ill defined junctional zone in 3D ultrasound” was seen in 26 cases (86%), which was also observed to be highest. With the cut off values taken for PI,RI and Vmax, diagnosis of leiomyoma was found to be 93.4% sensitive, 95.6% specific and with a positive predictive value of 97.6% and negative predictive value of 88.6%. Diagnosis of adenomyosis showed a sensitivity of 95.6%, specificity of 93.4% and a positive predictive value of 88.6% and negative predictive value of 97.6%. Imaging dignosed the co-existence of both the conditions correctly in 8 (66%) cases.

Conclusion

The parameters of blood flow impedance (that is PI, RI, and Vmax) of arteries within or around the uterine lesions revealed a consistent and significant difference between leiomyoma and adenomyosis. So apart from morphological criteria used in 3D TAS and TVS, aid of color Doppler can more accurately differentiate and diagnose these conditions. Myometrium, Pulsality Index (PI), Resistive Index (RI) DOI: 10.7860/JCDR/2015/12240.5846 Date of Submission: Nov 22, 2014 Date of Peer Review: Jan 15, 2015 Date of Acceptance: Feb 04, 2015 Date of Publishing: Apr 01, 2015 Financial OR OTHER COMPETING INTERESTS: None. - Emerging Sources Citation Index (Web of Science, thomsonreuters) - Index Copernicus ICV 2017: 134.54 - Academic Search Complete Database - Directory of Open Access Journals (DOAJ) - Embase - EBSCOhost - Google Scholar - HINARI Access to Research in Health Programme - Indian Science Abstracts (ISA) - Journal seek Database - Popline (reproductive health literature) - www.omnimedicalsearch.com

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Condition tags

adenomyosischronic_pelvic_paindysmenorrhea

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