Doppler ultrasound assessment of uterine artery blood flow in women with adenomyosis

Хушвахтова Эргашой Хушвахтовна, Dilfuza Akilova, D. M. Akilova, Narzullaeva ZR, Z. R. Narzullaeva
In: Health care of Tajikistan · 2026 · pp. 107–115 · doi:10.52888/0514-2515-2026-370-3-107-115 · W7221125528
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This prospective study found that uterine artery blood flow in adenomyosis varies by stage, showing decreased vascular resistance in stage I and pseudonormalized hemodynamics in stage II compared to healthy controls.

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This prospective cohort study evaluated uterine artery hemodynamics in 45 reproductive-age women, comparing 31 patients with stage I or II adenomyosis against a control group of 14 healthy individuals. Spectral Doppler ultrasound revealed that stage I adenomyosis is associated with significantly reduced vascular resistance, indicating enhanced local vasculature and arteriolar tone reduction. In contrast, stage II disease exhibited a phenomenon of "pseudonormalization" in pulsatility index, which the authors suggest may reflect structural myometrial remodeling, fibrosis, or vascular compression as the condition progresses. The paper concludes that the uterine hemodynamic profile in adenomyosis is dynamic, shifting from hyper-vascularization in early stages to increased resistance during disease progression. This paper is centrally about adenomyosis — specifically characterizing the changes in uterine artery blood flow across different stages of the disease using Doppler ultrasound.

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Abstract

Objective: to investigate changes in uterine artery blood flow across stages I–II of adenomyosis. Material and methods : a prospective cohort study was conducted in 45 women of reproductive age. The main group consisted of 31 patients with adenomyosis (18 with stage I, 13 with stage II). The control group included 14 healthy women without gynecological or other medical condition. All participants underwent spectral Doppler examination of the uterine arteries with assessment of the pulsatility index (PI), resistance index (RI), and systolic-diastolic ratio. Statistical analysis was performed using the Mann-Whitney U test. Results : the study demonstrated pronounced stage-dependent variability of uterine artery blood flow parameters in adenomyosis. In stage I adenomyosis, a significant decrease in vascular resistance compared to the control group was observed (RI 0.77±0.003 vs 0.91±0.005; p<0.001), which may reflect enhanced local vascularization and reduced arteriolar tone. In stage II adenomyosis, a phenomenon of “pseudonormalization” of hemodynamic parameters was identified (PI 2.97±0.003), which could be indirectly related to subsequent structural remodeling of the myometrium, including possible fibrotic changes and vascular compression. Conclusions: the hemodynamic profile of uterine arteries in adenomyosis is dynamic and changes with disease progression: from hypervascularization and decreased vascular resistance in early stages to a relative increase in vascular resistance.
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Допплерометрическая характеристика кровотока в маточных артериях у женщин при аденомиозе https://doi.org/10.52888/0514-2515-2026-370-3-107-115 Аннотация Цель: оценить изменения гемодинамики в маточных артериях при аденомиозе I-II степени. Материал и методы: проведено проспективное когортное исследование 45 женщин репродуктивного возраста. Основную группу составили 31 пациенток с аденомиозом (18 случаев - I степень, 13 случаев - II степень). Контрольную группу составили 14 женщин без гинекологической патологии и соматических заболеваний. Всем пациенткам проводилась спектральная допплерометрия маточных артерий с расчетом пульсационного индекса (ПИ), индекса резистентности (ИР) и систоло-диастолического отношения (СДО). Статистический анализ выполнен с использованием U-критерия Манна-Уитни. Результаты: при I степени отмечается снижение сосудистого сопротивления (ИР 0,77±0,003 против 0,91±0,005 в контроле; p<0,001), что, вероятно, отражает усиление локальной васкуляризации и снижение тонуса артериол. При II степени заболевания отмечен феномен «псевдонормализации» показателей (ПИ 2,97±0,003), который может быть косвенно связан с последующими структурными перестройками миометрия, включая возможное развитие фиброзных изменений и компрессию сосудистого русла. Заключение: гемодинамический профиль матки при аденомиозе не является статичным, а трансформируется от гиперваскуляризации на начальных этапах к повышению резистентности при прогрессировании процесса. Об авторах Э. Х. ХушвахтоваТаджикистан Хушвахтова Эргашой Хушвахтовна - доктор медицинских наук, доцент, ведущий научный сотрудник гинекологического отдела Душанбе Д. М. Акилова Таджикистан Акилова Дилфуза Музаффаровна - заочный аспирант Душанбе З. Р. Нарзуллаева Таджикистан Нарзуллаева Заррина Рахматуллаевна - к.м.н., доцент, зав.отд. функциональной диагностики Душанбе Список литературы 1. Адамян Л.В., Андреева Е.Н., Артымук Н.В. и др. Эндометриоз: диагностика, лечение и реабилитация. Клинические рекомендации. Проблемы репродукции. 2021;27(3):1-103. 2. Буланов М.Н. Ультразвуковая гинекология: курс лекций. В 2 т. Том 2. М.: Видар-М; 2014. 512 с. 3. Озерская И.А. Эхография в гинекологии. 2-е изд., перераб. и доп. М.: Видар-М; 2013. 564 с. 4. Радзинский В.Е., Фукс А.М. Гинекология: учебник. М.: ГЭОТАР-Медиа; 2016. 1000 с. 5. Bourdon M, Santulli P, Oliveira J, et al. Focal adenomyosis is associated with higher severity of deep endometriosis. Fertil Steril. 2021;115(2):464-472. DOI: 10.1016/j.fertnstert.2020.08.026 6. Chapron C, Vannuccini S, Santulli P, et al. Diagnosing adenomyosis: an integrated clinical and imaging approach. Hum Reprod Update. 2020;26(3):392-411. DOI: 10.1093/humupd/dmz049 7. Exacoustos C, Manganaro L, Zupi E. Imaging for the diagnosis of adenomyosis. Curr Opin Obstet Gynecol. 2014;26(4):265-271. DOI: 10.1097/GCO.0000000000000083 8. Harada T, Khine YM, Kaponis A, et al. The Impact of Adenomyosis on Women’s Fertility. Obstet Gynecol Surv. 2016;71(9):557-568. DOI: 10.1097/OGX.0000000000000346 9. Van den Bosch T, Dueholm M, Leone FP, et al. Terms, definitions and measurements to describe sonographic features of myometrium and uterine masses: a consensus opinion from the Morphological Uterus Sonographic Assessment (MUSA) group. Ultrasound Obstet Gynecol. 2015;46(3):284-298. DOI: 10.1002/uog.14806 10. Vannuccini S, Tosti C, Carmona F, et al. Pathogenesis of adenomyosis: an update on molecular mechanisms. Reprod Biomed Online. 2017;35(5):592-601. DOI: 10.1016/j.rbmo.2017.06.016 11. Zhai J, Vannuccini S, Petraglia F, Giudice LC. Adenomyosis: Mechanisms and Pathogenesis. Semin Reprod Med. 2020;38(2-03):129-143. DOI: 10.1055/s-0040-1716687 Рецензия Для цитирования: Хушвахтова Э.Х., Акилова Д.М., Нарзуллаева З.Р. Допплерометрическая характеристика кровотока в маточных артериях у женщин при аденомиозе. Здравоохранение Таджикистана. 2026;(3):107-115. https://doi.org/10.52888/0514-2515-2026-370-3-107-115 For citation: Khushvakhtova E.Kh., Akilova D.M., Narzullaeva Z.R. Doppler ultrasound assessment of uterine artery blood flow in women with adenomyosis. Health care of Tajikistan. 2026;(3):107-115. (In Russ.) https://doi.org/10.52888/0514-2515-2026-370-3-107-115 JATS XML

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