To evaluate the accuracy of different transvaginal sonographic criteria in the diagnosis
of adenomyosis, and to determine the most useful sonographic feature by comparison
with histopathologic results.
A total of 213 consecutive patients scheduled for hysterectomy underwent preoperative
transvaginal sonography in this retrospective study. The diagnosis of adenomyosis
was made if one or more of the following sonographic findings were present: (1) a
globular uterine configuration; (2) poor definition of the endometrial-myometrial
interface; (3) sub-endometrial echogenic linear striations; (4) myometrial anterior-posterior
asymmetry; (5) myometrial cysts; and (6) a heterogeneous myometrial echotexture. These
sonographic findings were then compared with the histopathologic findings.
The prevalence of adenomyosis was 39.9%. The sensitivity, specificity, positive and
negative predictive values, and accuracy of transvaginal ultrasound for the diagnosis
of adenomyosis were 87.1, 60.1, 59.2, 87.5 and 70.9%, respectively. We found that
subendometrial echogenic linear striations, a heterogeneous myometrial echotexture,
and myometrial anterior-posterior asymmetry showed greater accuracy for the diagnosis
of adenomyosis. Further evaluation of these findings showed that subendometrial echogenic
linear striations had the best sensitivity, and positive and negative predictive values
for the diagnosis of uterine adenomyosis (91.8, 67.8 and 92.9%, respectively). The
presence of a globular uterine configuration was the most specific sonographic feature
(78.1%), but showed poor specificity (50.6%).
The presence of subendometrial echogenic linear striations, a heterogeneous myometrial
echotexture, and myometrial anterior-posterior asymmetry on transvaginal ultrasonography
supports the diagnosis of adenomyosis. Among the transvaginal ultrasonographic findings
consistent with the diagnosis of adenomyosis, subendometrial linear striations had
the highest diagnostic accuracy.