OC08.01: Could comparative elastography help in the sonographic diagnosis of adenomyosis?

To compare the stiffness ratios of an apparently normal myometrium and a myometrium that meets the criteria for adenomyosis. A cross section study was designed in a university centre, from April to July 2017. Women were classified in three groups. Group 1 (G1) included patients with sonographic criteria of adenomyosis and endometriosis, Group 2 (G2) was comprised of women with endometriosis without adenomyosis and Group 3 (G3) was composed of women without any uterine pathology. G2 and G3 were considered control groups. Using a comparative elastography, two ROI were set. In G1 ROI1 was placed in heterogeneous myometrium suggesting adenomyosis sonographic criteria, and ROI2 in normal myometrium. In G2 and G3, one ROI was placed in anterior myometrium and the other in posterior myometrium. Then ratios ROI2/ROI1 were calculated and compared between groups using ANOVA test (SPSS v19.1). 111 women were included: 32 in G1, 41 in G2 and 38 in G3. The average age was 38.0 ± 4.5 G1, 37.9 ± 6.7 G2 and 43.1 ± 14.8 G3. The average ratios of ROI2/ROI1 were calculated (G1 2,31 ± 1,79, G2 1,43 ± 1,43 and G3 1,24 ± 0,94. A statistically significance was observed comparing averages between G1 and G2 (1,43; p = 0.026) and comparing G1 and G3 (1,62; p = 0.01). Among patients with adenomyosis, 65,6% showed ROI2/ROI1> 1, which means adenomyosis is harder than healthy myometrium, with a mean ratio of 3.3 ± 1.5, whereas only 34,3% had ratios < 1, which supposes a softer adenomyosis. Ratios of patients with endometriomas (N = 45) and DIE (N = 61) showed no statistical differences. The elastography ratios of adenomyotic uterus are higher than those of normal myometrium in healthy patients and patients with endometriosis. Although adenomyosis showed stiffer myometrium, different hardness was found in these patients probably due to different components such as glandular, stromal or vascular factors as well as evolution time, moment of menstrual cycle, parity and hormonal treatment. In conclusion, elastosonography could help in diagnosis of adenomyosis, but more studies are needed.