Ultrasound diagnosis of adenomyosis: new technologies – new approaches

To date, one of the most common endometriosis types is uterine endometriosis (adenomyosis). Persistent adenomyosis in older age is followed by worsening of complaints associated with a high frequency of chronic pelvic pain syndrome, menorrhagia, abnormal uterine bleeding, and dyspareunia. Objective. To determine the efficacy of two- and three-dimensional ultrasound in the diagnosis of adenomyosis in patients in the late reproductive and perimenopausal periods. Patients and methods. A total of 143 patients with adenomyosis were included in the study and divided into two groups: group 1 – 65 patients in the late reproductive period, group 2 – 78 patients in the perimenopause. The thickness, volume and structure of the endometrium, qualitative hemodynamic parameters of uterine terminal vessels were determined in 2D mode. In 3D mode, volumetric indices of blood flow in the endometrium and sub-endometrium were calculated. Results. Adenomyosis in the late reproductive and perimenopausal periods is associated with changes in the morpho-functional state of the endometrium due to elevated blood flow resistance in uterine terminal vessels. The vascularization index (VI) should be considered the most objective 3D blood flow parameter. Conclusion. A comprehensive 2D/3D ultrasound is a reliable method of adenomyosis diagnosis in patients in the late reproductive and perimenopausal periods. 3D ultrasound is an additional objective method to assess the endometrial volume and hemodynamics in the terminal branches of the radial artery. Key words: adenomyosis, three-dimensional ultrasound, junctional zone