Importance of Transvaginal Elastography in the Diagnosis of Uterine Fibroids and Adenomyosis

Purpose: To evaluate normal uterine tissue with special regard to age and the presence of uterine fibroids and adenomyosis with transvaginal elastography. Materials and Methods: In a prospective study elastographic data of the uterus were obtained in 206 unselected women with transvaginal ultrasound. Women who presented without any uterine pathology in ultrasonography were included in a control group, women with uterine fibroids in a uterine fibroid group, and women with adenomyosis in an adenomyosis group. In the control group strain values were measured at two regions of interest (ROIs) placed one upon the other in the anterior inferior uterine segment during a cycle of compression. The maximum strain ratio (ROI1/ROI2) was stored as the age index. In all groups strain values were measured at two ROIs placed side by side in a uterine fibroid (uterine fibroid group) or adenomyosis (adenomyosis group) or healthy homogeneous tissue (control group) and adjacent healthy tissue. Maximum strain ratios (ROI3/ROI4) were stored as the lesion index. Results: The age index was significantly negatively correlated with the age of the women (r = -0.49, p < 0.001). The median lesion indices were significantly (p < 0.001) different between the uterine fibroid, adenomyosis and control groups. Median lesion indices were 2.65, 0.44 and 1.19, respectively. Conclusion: The age index shows that normal uterine tissue has a certain age-dependent stiffness that increases with age. The lesion index allows for the assessment of the presence of a uterine fibroid or adenomyosis and helps to differentiate between both focal findings. Thus the use of elastography in addition to conventional ultrasound could help to diagnose uterine focal lesions and may be useful in preoperative planning.