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. 2021 Aug 16:76:e2981.
doi: 10.6061/clinics/2021/e2981. eCollection 2021.

Association of 2D and 3D transvaginal ultrasound findings with adenomyosis in symptomatic women of reproductive age: a prospective study

Ana Luiza Santos Marques  1 , Marina Paula Andres  1   2 , Leandro A Mattos  3 , Manoel O Gonçalves  4 , Edmund Chada Baracat  1 , Mauricio Simões Abrão  1   2
Affiliations

Association of 2D and 3D transvaginal ultrasound findings with adenomyosis in symptomatic women of reproductive age: a prospective study

Ana Luiza Santos Marques et al. Clinics (Sao Paulo). .

Abstract

Objective: To evaluate the association of two-dimensional (2D) and three-dimensional (3D) transvaginal ultrasound (TVUS) findings with adenomyosis symptoms.

Methods: This prospective study conducted between January and December 2018 enrolled 78 women aged 18 to 40 years with abnormal uterine bleeding (AUB), infertility, and/or pelvic pain. All patients underwent 2D and 3D TVUS. Signs of adenomyosis on TVUS were identified according to the consensus of the Morphological Uterus Sonographic Assessment group.

Results: The prevalence of adenomyosis on TVUS was 55.12%. Patients with adenomyosis were older (p=0.002) and had more dysmenorrhea, AUB, and endometriosis than those without adenomyosis. When comparing the presence of symptoms with each adenomyosis feature, on 2D TVUS, severe dyspareunia was significantly associated with the presence of a poorly defined junctional zone (JZ) (p=0.023) and on 3D TVUS, patients with AUB had a more irregular (p=0.003), poorly defined (p=0.028), and interrupted JZ (p=0.011). After logistic regression analysis, signs of adenomyosis on TVUS remained significantly associated only with age over 30 years (OR: 1.2; 95% CI: 1.0-1.2) and AUB (OR: 7.65; 95% CI: 2-29). Patients with diffuse adenomyosis were older and presented with more infertility and AUB than patients with focal or no adenomyosis.

Conclusion: The findings of adenomyosis by 2D and 3D TVUS showed association with age and AUB. 3D TVUS alterations in the JZ were associated with AUB and dyspareunia. Diffuse adenomyosis was associated with older age, a greater prevalence of infertility, and AUB.

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Conflict of interest statement

No potential conflict of interest was reported.

Figures

Figure 1
Figure 1. Flowchart of included patients.
Figure 2
Figure 2. Two-dimensional ultrasound imaging of a uterus in a longitudinal section showing typical sonographic features of adenomyosis. A. Note the asymmetry of the myometrial wall (posterior wall thicker than anterior wall) and the heterogeneous myometrium with hypoechoic linear striae (arrows). B. Poorly defined junctional zone (arrows).
Figure 3
Figure 3. Three-dimensional ultrasound imaging of a uterus with adenomyosis in the coronal plane. A. Protrusions of the endometrium into the junctional zone (JZ) (arrows). B. Junctional zone thickened, interrupted, and infiltrated by subendometrial echogenic nodules (buds) (arrows). In this image, the JZ difference is 6.8 mm.
Figure 4
Figure 4. Three-dimensional ultrasound imaging of a uterus in the coronal plane showing focal adenomyosis of the inner myometrium: junctional zone interrupted with one hyperechogenic island (arrows).
Figure 5
Figure 5. Two-dimensional ultrasound imaging of a uterus in the sagittal plane showing a focal adenomyosis of the outer myometrium: a heterogeneous uterus with adenomyoma and an irregular junctional zone (arrows and asterisks).
Figure 6
Figure 6. Two and three-dimensional ultrasound imaging of a uterus with diffuse type adenomyosis. A. Heterogeneous uterus with an irregular and interrupted junctional zone associated with myometrial cysts (arrows). B. Severe diffuse adenomyosis. Globular, enlarged, and heterogeneous uterus with myometrial cysts and an ill-defined junctional zone, completely infiltrated by adenomyosis (arrows and asterisks).
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