Ultrasound studies of the endometrial-myometrial junction for the diagnosis of adenomyosis and endometrial cancer

This thesis investigated the ultrasound assessment of the endometrial-myometrial junction (EMJ) and its clinical relevance to the uterine diseases, adenomyosis and endometrial cancer. The inter- and intraobserver variability in the classification of EMJ visualisation using three-dimensional ultrasound was assessed and a high level of agreement was found. Endometrial thickness and parity were found to be significantly associated with the quality of EMJ visualisation. Seven recognised ultrasound features of adenomyosis, including an irregular endometrial-myometrial junction, were investigated for their role in the ultrasound diagnosis of adenomyosis. The other features were an asymmetrically thickened myometrium, parallel shadowing, linear striations, myometrial cysts, hyperechoic lesions and adenomyomas. The presence of any of these features was considered diagnostic of adenomyosis. The inter- and intraobserver variability of ultrasound diagnosis of adenomyosis was also investigated and a good level of agreement was found. This was the case when real-time ultrasound assessments were compared with assessments made from stored uterine volumes, as well as when both assessments were made from stored volumes. Transvaginal ... (continues)