Comparison of uterine transcornual diameter using 3D-transvaginal ultrasound between adenomyotic and normal uteri

In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2024 · vol. 14(1) , pp. 58–62 · doi:10.18203/2320-1770.ijrcog20243792 · W4405530620
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AI-generated summary by claude@2026-06, 2026-06-28

This study found that the mean transcornual diameter of the uterine cavity in adenomyotic uteri was significantly larger than in normal uteri using 3D-transvaginal ultrasound.

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The study investigated whether adenomyosis is associated with differences in transcornual diameter of the uterine cavity on coronal-plane luteal-phase 3D transvaginal ultrasound. It included 768 women aged 33–44 years referred to a single 4D scan center (August 2019–August 2023), with 384 cases with diffuse adenomyosis diagnosed using ≥4 Morphological Uterus Sonographic Assessment (MUSA) criteria and 384 controls with normal-sized uteri. The mean transcornual diameter was 39 mm (±6) in adenomyosis cases versus 24 mm (±8) in controls, and this difference was statistically significant. Limitations acknowledged include that adenomyosis was defined by MUSA criteria and the cohort came from one center, and the “<35 mm” cutoff is presented as an extrapolation from these data; This paper is centrally about endometriosis and/or adenomyosis — it specifically examines adenomyosis using 3D-TVUS uterine transcornual diameter as a diagnostic marker.

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Abstract

Background: Various sonographic markers for diagnosis of adenomyosis had been published by the morphological uterus sonographic assessment (MUSA) group. Most of their data based on two dimensional transvaginal ultrasound (2D-TVUS) findings. Our study aimed to find if there is a relation between the presence of adenomyosis uteri and the transcornual diameter. Methods: We had studied 768 cases (33-44 years old) who were referred to Habashy 4D scan center (Alexandria; Egypt) between August 2019 and August 2023. We had divided cases into two groups; each with 384 cases. First group has diffused adenomyosis and the second group has normal uterus. We had diagnosed adenomyosis based in the presence of ≥4 of the MUSA criteria. In the control group; we had selected cases with normal sized uterus. We had compared the transcornual diameter of the uterine cavity in the coronal plane between both groups using 3D-TVUS during the luteal phase of the cycle. Results: The mean transcornual diameter in cases who had adenomyosis was 39 mm (±6 mm). The mean transcornual diameter in the control group was 24 mm (±8 mm). Conclusions: The mean transcornual diameter of the uterine cavity in the coronal plane using luteal 3D-TVUS in adenomyotic uteri was statistically significantly higher than in the controls. To the best of our knowledge, our study is the first study in literature that compare the transcornual diameter adenomyotic and normal uteri. We can extrapolate from our data to assume that transcornual diameter <35 mm can be used as an exclusion for diagnosis of cases as having adenomyosis uteri.
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Background

Various sonographic markers for diagnosis of adenomyosis had been published by the morphological uterus sonographic assessment (MUSA) group. Most of their data based on two dimensional transvaginal ultrasound (2D-TVUS) findings. Our study aimed to find if there is a relation between the presence of adenomyosis uteri and the transcornual diameter.

Methods

We had studied 768 cases (33-44 years old) who were referred to Habashy 4D scan center (Alexandria; Egypt) between August 2019 and August 2023. We had divided cases into two groups; each with 384 cases. First group has diffused adenomyosis and the second group has normal uterus. We had diagnosed adenomyosis based in the presence of ≥4 of the MUSA criteria. In the control group; we had selected cases with normal sized uterus. We had compared the transcornual diameter of the uterine cavity in the coronal plane between both groups using 3D-TVUS during the luteal phase of the cycle.

Results

The mean transcornual diameter in cases who had adenomyosis was 39 mm (±6 mm). The mean transcornual diameter in the control group was 24 mm (±8 mm).

Conclusions

The mean transcornual diameter of the uterine cavity in the coronal plane using luteal 3D-TVUS in adenomyotic uteri was statistically significantly higher than in the controls. To the best of our knowledge, our study is the first study in literature that compare the transcornual diameter adenomyotic and normal uteri. We can extrapolate from our data to assume that transcornual diameter <35 mm can be used as an exclusion for diagnosis of cases as having adenomyosis uteri. Metrics

References

Dason ES, Maxim M, Sanders A, Papillon-Smith J, Ng D, Chan C, et al. Guideline No. 437: Diagnosis and Management of Adenomyosis. J Obstet Gynaecol Can. 2023;45(6):417-29.e1. Ferenczy A. Pathophysiology of adenomyosis. Hum Reprod Update. 1998;4(4):312-22. Naftalin J, Hoo W, Pateman K, Mavrelos D, Holland T, Jurkovic D. How common is adenomyosis? A prospective study of prevalence using transvaginal ultrasound in a gynaecology clinic. Hum Reprod. 2012;27(12):3432-9. Pinzauti S, Lazzeri L, Tosti C, Centini G, Orlandini C, Luisi S, et al. Transvaginal sonographic features of diffuse adenomyosis in 18-30-year-old nulligravid women without endometriosis: association with symptoms. Ultrasound Obstet Gynecol. 2015;46(6):730-6. Tellum T, Nygaard S, Lieng M. Noninvasive Diagnosis of Adenomyosis: A Structured Review and Meta-analysis of Diagnostic Accuracy in Imaging. J Minim Invasive Gynecol. 2020;27(2):408-18e3. Harmsen MJ, Van den Bosch T, de Leeuw RA, Dueholm M, Exacoustos C, Valentin L, et al. Consensus on revised definitions of Morphological Uterus Sonographic Assessment (MUSA) features of adenomyosis: results of modified Delphi procedure. Ultrasound Obstet Gynecol. 2022;60(1):118-31. Harmsen MJ, Van den Bosch T, de Leeuw RA, Dueholm M, Exacoustos C, Valentin L, et al. Consensus on revised definitions of Morphological Uterus Sonographic Assessment (MUSA) features of adenomyosis: results of modified Delphi procedure. Ultrasound Obstet Gynecol. 2022;60(1):118-31. Biasioli A, Degano M, Restaino S, Bagolin M, Moro F, Ciccarone F, et al. The Udine Hospital Endometriosis Group. Innovative Ultrasound Criteria for the Diagnosis of Adenomyosis and Correlation with Symptoms: A Retrospective Re-Evaluation. Biomedicines. 2024;12(2):463. Ludwin A, Martins WP. Correct measurement of uterine fundal internal indentation depth and angle: an important but overlooked issue for precise diagnosis of uterine anomalies. Ultrasound Obstet Gynecol. 2021;58(3):497-9. Abdel-Naby MA, and El-Said R. OP31.02: 3D ultrasound novel geometric measures for normally appearing uterine cavity in nulliparous females in reproductive age. Ultrasound Obstet Gynecol. 2014;44:161-2. Raimondo D, Lazzeri L, Raffone A, Giorgi M, Orsini B, Verrelli L, et al. Sonographic Assessment of Uterine Biometry for the Diagnosis of Diffuse Adenomyosis in a Tertiary Outpatient Clinic. J Pers Med. 2022;12(10):1572. Bergholt T, Eriksen L, Berendt N, Jacobsen M, Hertz JB. Prevalence and risk factors of adenomyosis at hysterectomy. Hum Reprod. 2001;16(11):2418-21. Weiss G, Maseelall P, Schott LL, Brockwell SE, Schocken M, Johnston JM. Adenomyosis a variant, not a disease? Evidence from hysterectomized menopausal women in the Study of Women's Health Across the Nation (SWAN) Fertil Steril. 2009;91(1):201-6. Taran FA, Weaver AL, Coddington CC, Stewart EA. Characteristics indicating adenomyosis coexisting with leiomyomas: a case-control study. Hum Reprod. 2010;25(5):1177-82. Exacoustos C, Morosetti G, Conway F, Camilli S, Martire FG, Lazzeri L, et al. New Sonographic Classification of Adenomyosis: Do Type and Degree of Adenomyosis Correlate to Severity of Symptoms? J Minim Invasive Gynecol. 2020;27(6):1308-15.

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Outcome instruments

MUSA

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adenomyosis

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