VP06.02: Added value of strain sonoelastography in the diagnosis of uterine pathology: an explorative descriptive case series

Ultrasound strain sonoelastography assesses tissue stiffness, adding supplemental information to real time dynamic transvaginal ultrasound. Stiffness shows as a colour quantitative elastogram superimposed on a B-mode image. It is a well-established technique in non-gynecological pathology, yet it has not been endorsed by international gynecological ultrasound guidelines. The aim is to explore the added value of strain sonoelastography in the evaluation of uterine lesions. We present an explorative descriptive case series of 53 women presenting at the UZ Leuven gynecology ultrasound centre with various uterine pathologies. Strain elastography using a VolusonTM E10 ultrasound machine (GE Healthcare) was performed after sonographic diagnosis using B-mode sonography and power Doppler by an expert clinician. Histology was available in 14/53 cases. The minimal internal ultrasound machine control value was set at 5/6. The colour scale varies from red (soft) to blue (hard). Fifty cases were included. In general, myometrium appeared stiffer than endometrial tissue. Most fibroids were stiffer than the surrounding myometrium and well demarcated, whereas adenomyosis was softer with irregular borders. Endometrial polyps had a soft consistency, while intracavitary fibroids and endometrial cancer looked stiffer. Retained products of conception appeared harder, whereas intracavitary blood was very soft. In most lesion, semi-quantitative calculations were found to be difficult and subjective due to tissue heterogeneity. Strain sonoelastography may proof of added value in the detection and differential diagnosis of myometrial and intracavitary lesions. Pattern recognition of the colour map may proof more useful in clinical practice than semi-qualitative calculations. The diagnostic benefit for uterine lesions needs to be assessed in further studies.