P07.06: Comparison of saline infusion sonohysterography (SIS) with unenhanced ultrasound in the diagnosis of uterine adenomyosis

The aim of this study is to evaluate the value of saline infusion sonohysterography (SIS) as compared to unenhanced ultrasound in the diagnosis of adenomyosis. A prospective study of women suspected of having adenomyosis based on clinical and/or radiological findings. Gray scale ultrasound was first used to diagnose the presence of adenomyosis using predetermined ultrasound criteria: globular shaped uterus, myometrial cysts, mottled inhomogenous myometrium, indistinct borders to a myometrial mass, indistinct endometrial stripe, hyperechoic myometrial nodules, asymmetric thickening of the anterior or posterior uterine walls and minimal mass effect on the endometrium or serosa. Cases were then examined by another operator (blinded to the original results) with SIS using a pediatric Foley's catheter (to avoid failure due to inadequate distension). Criteria for diagnosis were the same as in unenhanced ultrasound in addition to communicating crypts between the endometrium and myometrium. Abdominal hysterectomy was done for all patients and histopathological diagnosis was the gold standard. Fifty premenopausal patients were enrolled in the study. The prevalence of adenomyosis was 80% (40/50 patients. Communicating myometrial crypts could be visualized in 6 cases during SIS. In 4 of them (75%), unenhanced ultrasound could not confirm the presence of adenomyosis. Sensitivity and specificity of unenhanced ultrasound for the diagnosis of adenomyosis were 87.5% and 70% respectively and it increased to 92.5% and 78% with the use of SIS. In cases where the diagnosis of adenomyosis was still doubtful by unenhanced ultrasound, SIS improved the sensitivity and specificity due to enhancement of myometrial imaging and the visualization of myometrial crypts.