OC22.05: *3D transvaginal ultrasound in adenomyosis: are we looking at all there is?

The ultrasound diagnosis of adenomyosis is mainly based on pattern recognition, which is subjective and inaccurate. The investigation of objective, quantitative markers is therefore central in order to improve the diagnosis of adenomyosis. While in MRI the junctional zone (JZ) is mainly measured in the longitudinal plane, ultrasound-studies mainly use the coronal plane. We investigated the use of the longitudinal plane in 3D-volumes for the diagnosis of adenomyosis. In this prospective, observational study 96 premenopausal women aged 30-50 years underwent 2D- and 3D-transvaginal ultrasound, MRI, hysterectomy and histopathological examination of the specimen. We assessed and documented the sonographic appearance of the uterus and the JZ according to the consensus presented by the MUSA-group. The junctional zone was measured and evaluated in the coronal and the longitudinal plane separately. Adenomyosis was found in 59 (62%) and not found in 35 (37%) women. In two cases (2%) the pathologist was not certain of the diagnosis. The JZ was visible in the coronal plane in 64 (68%) and in the longitudinal plane in 43 (46%) cases. The highest (JZmax), the lowest (JZmin) and the difference (JZmax-JZmin) of JZ-measurements were compared amongst the groups with and without adenomyosis. Only JZmax in the longitudinal plane showed a significant difference (mean 5,7 vs. 3,9mm; p=0,025) amongst the groups. JZmax also showed a fair test-quality (AUC=0,71; p=0,021), with a cut-off of JZmax>5,3mm yielding a specificity of 78% and sensitivity of 58%. The classification of “JZ not visible” was significantly associated with adenomyosis in both planes (p=0,01 and 0,04). We found, correspondingly to MRI, that measures of the JZ in the longitudinal, but not coronal view were a valid test for adenomyosis. However, the JZ was not visible or assessable in many cases and measurements not possible. Therefore, qualitative assessment of the JZ and the myometrium is still the best diagnostic tool overall.