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Adenomyosis: US Features with Histologic Correlation in an in Vitro Study¹

¹ From the Departments of Radiology (M.A., C.R., P.M.B.) and Pathology (A.R.M.), McGill University, Montreal General Hospital, Quebec, Canada; and the Departments of Pathology (W.B.C.) and Medical Imaging (M.A., P.M.B.), University of Toronto, University Health Network and Mount Sinai Hospital, 610 University Ave, Toronto, Ontario, Canada M5G 2M9. From the 1997 RSNA scientific assembly. Received July 16, 1999; revision requested August 25; revision received October 19; accepted October 26. Address correspondence to M.A. (e-mail: mostafa_atri@pmh.toronto.on.ca).

PURPOSE: To evaluate the accuracy of ultrasonographic (US) features of adenomyosis by correlating them with histologic findings and to assess inter- and intraobserver agreement.

MATERIALS AND METHODS: US was performed and videotaped in 102 consecutive hysterectomy specimens in a water bath. Videotapes were reviewed initially by two independent radiologists blinded to the clinical and histologic findings and after 1 month by one of the two; US and histologic findings were correlated. Features evaluated included diffuse abnormal echotexture of myometrium, subendometrial myometrial cysts, subendometrial echogenic nodules, subendometrial echogenic linear striations, nodular endometrial-myometrial junction, poor definition of the endometrial-myometrial junction, asymmetric thickness of the anteroposterior wall of the myometrium, and globular configuration.

RESULTS: The prevalence of adenomyosis in this cohort was 29.4% (30 of 102 specimens). The mean sensitivity, specificity, negative predictive value, positive predictive value (PPV), and accuracy for the diagnosis of adenomyosis for the three reviews were 81%, 71%, 90%, 54%, and 74%, respectively. All findings evaluated, except for nodular endometrial-myometrial junction, were significantly more common in uteri with adenomyosis (P < .05). Heterogeneous myometrium reached borderline significance (P = .05). The specificities and PPVs of subendometrial striations, subendometrial echogenic nodules, and asymmetric myometrial thickness were significantly higher than those of other features (P < .05). The interobserver agreement was moderate ( = 0.48), and the intraobserver agreement was good ( = 0.67) for the three reviews.

CONCLUSION: The presence of subendometrial linear striations, subendometrial echogenic nodules, or asymmetric myometrial thickness improves the specificity and PPV of US in diagnosing adenomyosis.

Index terms: Endometriosis, 854,3192 • Ultrasound (US), tissue characterization, 854.317, 854.3192 • Uterine neoplasms, diagnosis, 854.12981, 854.317, 854.3192 • Uterine neoplasms, US, 854.12981, 854.317, 854.3192 • Uterus, endometrium, 854.317, 854.3192 • Uterus, myometrium, 854.317, 854.3192 • Uterus, US, 854.12981, 854.317, 854.3192

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