Adenomyosis: What the sonographer needs to know
Kelly Foley-Friel, Medica Diagnostics, Ireland
Background
Adenomyosis is a benign gynaecological condition defined as growth of endometrial tissue within the myometrium (Chapron et al., 2020). It is a condition with varying symptoms resulting in a challenging clinical and imaging diagnosis. Ultrasound is the first-line imaging modality for adenomyosis. Technological advances within ultrasound have led to an increase in diagnosis compared with the formerly invasive diagnosis based on histopathology. Whilst transabdominal ultrasound has a limited role to play, transvaginal ultrasound (TVUS) has the capability in the hands of an experienced operator (Chapron et al., 2020).
Clinical presentation
There is no consensus amongst published literature regarding the pathogenesis of adenomyosis (Chapron et al, 2020). Patients can present with abnormal uterine bleeding, infertility and pelvic pain, however, in a small proportion it can be asymptomatic. The clinical bimanual examination accompanied with a detailed history raises suspicion of adenomyosis. Most physicians subsequently look to confirm their suspicions with ultrasound. Sonographic signs of adenomyosis TVUS allows for a dynamic scan assessing organ mobility and patient pain. Sonographic appearances suggestive of adenomysosis are the following: globular uterus, myometrial cysts, myometrium thickening (focal or diffuse), “venetian blind shadowing”, heterogenous myometrium, echogenic striations and poor endometrial–myometrial junctional zone. The presence of increased vascularity of the myometrium and translesional vascularity can be seen in patients with adenomyosis. Adenomyosis can also be evident with comorbidities such as endometriosis or fibroids (Van Den Bosch et al., 2015).
Discussion
MUSA’s (Morphological Uterus Sonographic Assessment) goal was to provide standardisation for assessing and reporting adenomyosis. Whilst there is still no consensus regarding the most specific sonographic sign for adenomyosis, there is agreement the more sonographic signs evident increases the predictive value (Chapron et al., 2020). There is a need for continued awareness of the condition amongst sonographers and its associated sonographic signs.