OP17.06: Diagnosing adenomyosis using transvaginal contrast‐enhanced ultrasound: a pilot study

Heavy menstrual bleeding, dysmenorrhea and subfertility are common symptoms that are associated with adenomyosis. However, diagnosing adenomyosis remains challenging, leading to insufficient treatment options. Angiogenesis plays a pivotal role in adenomyosis, which is underlined by histological findings of abnormal microvasculature. Diagnosis may be improved by imaging the uterine microvasculature using contrast-enhanced ultrasound (CEUS). Besides visual assessment, quantitative contrast-ultrasound dispersion imaging (CUDI) can add insight into angiogenic processes. Our goals were 1) to determine the feasibility of uterine CEUS, and 2) to visualise and describe the adenomyotic uterus using CEUS qualitatively and quantitatively. We included 15 adult premenopausal patients with prominent direct adenomyosis features on B-mode ultrasound, and 1 healthy control. A 3-minute transvaginal 2D CEUS scan with a bolus injection of SonoVue™ was performed. The in- and outflow of the contrast agent in the uterus were analysed qualitatively and quantitatively. CEUS was well-accepted and easy to perform in all participants. The uterine macro- and microvasculature could be visualised. Myometrial vascularity and perfusion were homogeneous in the healthy uterus. Both parameters were heterogeneous in adenomyotic uteri, with interspersed hyper- and unvascularised spots. Compared to the healthy uterus, CUDI analysis of the adenomyotic uteri suggested higher microvascular density, tortuosity and irregularity, indicative of angiogenesis. There was a large variation in appearance on CEUS between adenomyotic uteri. CEUS is a technically and practically feasible technique for imaging adenomyotic uteri. Differences in the microvascularisation between the adenomyotic and healthy uterus can be visualised using CEUS. These promising results warrant a large prospective study to confirm our findings and to evaluate the diagnostic value of CEUS in the diagnosis of adenomyosis.