The Accuracy of Ultrasound Shear Wave Elastography in the Diagnosis of Adenomyosis

Abstract

A denomyosis is defined as benign invasion of endometrium into the myometrium in for endometrial glands and stroma surrounded by hypertrophic and hyperplastic smooth muscles. For several decades, the diagnosis of uterine adenomyosis was made in hysterectomy specimens either coincidently or in women treated surgically for chronic pelvic pain and / or abnormal uterine bleeding. This led to considering it a disease of late reproductive or premenopausal women. Over the past 20-30 years, more and more cases of adenomyosis are diagnosed with non-invasive methods as transvaginal sonography and magnetic resonance imaging. The shift towards non-invasive diagnostic modalities has been pivotal in changing our understanding of the natural history and clinical spectrum of this disorder. Till recently, the most common treatment method of uterine adenomyosis has been hysterectomy with many drawbacks as high health cost, lower quality of women's life and this method is not suitable for women who wish to get pregnant and those who refuse the operation. There is need for non-invasive diagnostic methods of this gynecological disorder that will lead to many advancements: 1)to know true prevalence, 2)to study risk factors and pathogenesis of this condition that may lead to development of preventive strategies and 3)to study and develop non-invasive treatment methods. To summerize the diagnostic methods of uterine adenomyosis that could be used: clinical diagnosis, TVS, MRI, elastosonography and the gold standard method which is pathological examination of hysterectomy samples Clincal picture: Clinical manifestations of this condition are dysmenorrhea, menorrhagia, and uterine enlargement. Clinical manifestations allow only presumptive diagnosis of this disorder. This is because one third of patients are asymptomatic and when there are symptoms; the symptoms are non-specific.