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MRI adds value after transvaginal ultrasound diagnosis of adenomyosis: supplementary diagnostic info.

CHICAGO -- Magnetic resonance imaging offers valuable information following transvaginal ultrasound diagnosis of adenomyosis, Dr. Thomas Zacharia reported at the annual meeting of the Radiological Society of North America.

Recent studies have suggested that transvaginal ultrasound (TVUS) approaches pelvic MRI in sensitivity and specificity for the diagnosis of adenomyosis. A retrospective review found that MRI gave important added value after TVUS diagnosis of adenomyosis in 88% of subjects.

MRI provided supplementary diagnostic information in 44% of patients, provided a diagnostic alternative in 33% of patients, and otherwise called into question the TVUS diagnosis in 11% of patients.

"Ultrasound should continue as a screening tool, [but] MRI should follow if ultrasound is suspicious," said Dr. Zacharia, a research fellow at Harvard Medical School, Boston, where the study was conducted.

A total of 65 patients with adenomyosis suspicious on ultrasound underwent static pelvic MRI exams within 30 days of TVUS between Jan. 1, 2001, and Jan. 1, 2003. Eight patients were excluded from the study based on a lack of sonographic criteria. The 57 remaining subjects were aged 36-53 years, with a mean of 46 years.

TVUS was considered diagnostic for adenomyosis if at least three of six criteria were present: myometrial cysts, asymmetric myometrial thickening, enlarged uterus, globular shaped uterus, small echogenic myometrial nodules, or pain during ultrasound examination.

MRI confirmed the diagnosis of adenomyosis if any one of three criteria were present: junctional zone thickness greater than 12 mm, junctional zone cysts, or an indistinct junctional zone.

MRI confirmed adenomyosis in 32 (56%) of the 57 patients, but in 25 patients (44%) there was no MRI evidence of adenomyosis.

The findings at ultrasound were explained in 19 (33%) of the 57 patients by an alternative diagnosis of multiple small myometrial fibroids in 18 patients and a uterine arteriovenous malformation in 1 patient. The remaining six patients (11%) had a normal-appearing uterus on MRI without any explanation of sonographic findings.

MRI did not reveal any additional adnexal findings not identified by TVUS.

While the MRI and TVUS diagnoses correlated in 32 patients, additional findings not suspected on TVUS were discovered in 25 of these patients (44% of the 57 subjects in the study). Twenty patients were found to have myometrial fibroids in addition to adenomyosis, and 11 had unsuspected findings within the adnexae associated with endometriosis.

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Title Annotation:Women's Health
Author:Norton, Patrice G.W.
Publication:Family Practice News
Geographic Code:1USA
Date:Mar 1, 2004
Words:384
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