OC01

The purpose of this study was to compare the accuracy of transvaginal sonography (TVS) with that of magnetic resonance imaging (MRI) for the diagnosis of adenomyosis. The study population comprised 87 premenopausal patients who underwent transabdominal hysterectomy. The indications for hysterectomy were abnormal uterine bleeding in 34 (39.1%) patients, symptomatic myomas in 24 (27.6%), lower abdominal pain and/or endometriosis in 13 (14.9%), adnexal masses in 11 (12.6%) and cervical intraepithelial neoplasia in five (5.7%). Mean age of patients was 48.2 (range, 39–55) years. Diagnosis of adenomyosis by TVS was based on criteria including presence of cystic anechoic spaces or lakes in the myometrium, posterior uterine wall thickening, subendometrial echogenic linear striations, heterogeneous echotexture and obscure endometrial/myometrial border. MRI criteria used were presence of intramyometrial cyst(s), heterogeneous myometrium, usually heterogeneously hyperintense, and thickening of the junctional zone of the uterus (≥ 12 mm). MRI, TVS and pathologic examinations were performed independently and the findings were evaluated consecutively. TVS was always performed by the same experienced gynecologist. The pathologist who performed the histopathological examinations was blinded to ultrasound and MRI data. Pathology recognized 50 patients with adenomyosis. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of TVS were 84%, 91.9%, 93.3% and 80.9%, respectively. The sensitivity, specificity, PPV and NPV of MRI were 88%, 94.6%, 95.6% and 85.4%, respectively. The accuracies of TVS and MRI were 87.4% and 90.8%, respectively. Our results suggest that TVS and MRI have similar accuracy rates for the diagnosis of adenomyosis. Although MRI is more sensitive, TVS is less expensive, well tolerated and readily available to the majority of gynecologists.