Possibilities of ultrasound in the evaluation of uterine blood supply in patients with adenomyosis

Introduction. Ultrasound diagnosis of adenomyosis is based on features published in numerous literary sources. However, we should agree with Bulanov M. N. (2014), that this disease is the clear leader in the list of „difficult diagnosis” and the gravity of clinical manifestations may not reflect the severity of ultrasound signs. The aim of the study was to assess changes in the hemodynamics of uterine affected from adenomyosis. Material and methods. An ultrasound examination was conducted in 147 patients suffering from adenomyosis. The following modes and parameters were evaluated: the B-mode data, the power and color Doppler flow mapping (CDM) data, the pulsed wave Doppler data of uterine arteries with the calculation of volumetric blood flow and arterial perfusion index (API). Also, vascularization index (VI), the flow index (FI) and vascularization-flow index (VFI), obtained by 3D power and color Doppler reconstruction, were evaluated. These parameters were compared with data in analogous-age healthy women. In addition, outcomes among patients underwent surgery and those on conservative therapy were compared. Results. The findings showed an authentic (p <0,05) decrease of vascularization due to the arterial blood inflow in both phases of the menstrual cycle regardless of the clinical symptoms. A significant (p <0,05) decrease of blood flow and peripheral resistance index in the uterine arteries was observed in patients underwent surgery in comparison with patients receiving conservative treatment. Conclusions. Thus, in women with adenomyosis, not only the thickness of the endometrium should be measured, but also the volume, thereby increasing the accuracy of diagnosis of hyperplastic process. The most reliable indicators for assessing the hemodynamics are VI and IAP, which are sharply reduced in case of adenomyosis, regardless of the disease stage in both phases of the menstrual cycle.