Ultrasound In Adenomyosis
3D ULTRASONOGRAPHY
- It helps to visualise the junctional zone more clearly.
- On coronal view, the junctional zone can be identified as a hypoechoic area around the endometrium, an ill-defined junctional zone, and distortion or infiltration of the hypoechoic inner myometrium.
Colour Doppler studies
- Usage of colour doppler studies helps to improve the diagnostic accuracy of ultrasound findings.
- Presence of Intra myometrial cysts, or anechoic areas with the myometrial thickness of more than or equal to 1mm and with no blood flow.
- Overall there is increased vascularity in the stroma of the myometrium.
MRI
It is an excellent tool for management of adenomyosis. The main criteria for the definition of adenomyosis on MRI are
- Enlarged uterus with presence of a distinct myometrial mass with indistinct margins of primarily low intensity.
- Diffuse or local widening of junctional zones on T2 weighted image.
- Increased junctional zone thickness of more than equal to 0.15 mm; this could be localised or diffuse.
- Uterine enlargement – Globular uterine enlargement that is generally up to 12 cm in uterine length.
- Cystic anechoic spaces orlakes inthemyometrium (specific sign) – Variable in size and can occur throughout the myometrium- reflect glands filled with fluid.
- Uterine wall thickening – The uterine wall thickening typically of fundal and posterior wall can show anteroposterior asymmetry.
- Sub endometrial echogenic linear striations (specific sign) – Venetian bands or rain shower appearance. Invasion of the endometrial glands into the sub endometrial tissue induces a hyperplastic reaction, which appears as echogenic linear striations fanning out from the endometrial layer.
- Once the follicles have reached the optimal size and number (more than or equal to 2 follicles over 18 mm) for IVF the patient is given intramuscular inj HCG/recombinant HCG/GnRH agonists to trigger ovulation.
- Heterogeneous echotexture there is a lack of homogeneity within the myometrium with evidence of architectural disturbance.
- Obscure endometrial/myometrial border – Invasion of the myometrium by the glands obscures the normally distinct endometrial/myometrial border.
- Thickening of the transition zone – This zone is a layer that appears as a hypoechoic halo surrounding the endometrial layer.
- Diffuse Hypervascularity – Colour and power Doppler sonography often demonstrate diffuse hypervascularity without large feeding vessels.
- Question Mark sign – Seen when the uterine corpus is flexed backward, the fundus of the uterus is facing the posterior pelvic compartment and the cervix is directed anteriorly towards the urinary bladder. This alone has a high specificity.
That’s all about ultrasound in adenomyosis.