Keywords:
Genital / Reproductive system female, Ultrasound, MR, Comparative studies
Authors:
F. ARBAN, N. Starvaggi, F. GIUDICI, M. Gergolet, L. Bottaro, M. A. Cova; Trieste/IT
DOI:
10.26044/ecr2019/C-2539
Methods and materials
50 infertile women who underwent both TVUS and 1.5T MRI from January 2014 to December 2017 were retrospectively reviewed.
The inclusion criteria were:
- female infertility without hormonal causes
- normal male spermiogram
while the exclusion criterion was:
4 infertile women were excluded because they underwent 1.5T MRI during the incorrect cycle phase (menstrual phase) and for this reason,
finally,
we considered 46 patients (average age 38.5 years,
range 23-46 years).
All transvaginal ultrasounds were performed by an expert gynaecologist using a high frequency (5-9 MHz) transvaginal probe while all MRIs were performed by an expert radiologist using a high field magnet (1.5T),
high performance gradients (33 mT/m) and phased-array surface coils with the following sequences:
- TSE T2W sequences (on axial,
coronal and sagittal planes with also para-axial and para-coronal planes to evaluate congenital uterine anomalies)
- TSE T1W sequence (on axial plane)
- TSE T1W fat-suppressed sequence (on axial plane)
- FFE T2W sequence (on axial plane)
- DWI (on para-coronal plane with b-value=0,
600,
1000)
In 12 cases we performed TSE T1W fat suppressed sequences also after gadolinium iv.
injection for a differential diagnosis between leiomyoma and adenomyoma.
Diagnosis of adenomyosis in case of two or more of the following MUSA positive criteria was established by TVUS (5):
- Globular uterus (Fig.1)
- Asimmetrical thickening of the myometrial walls (Fig.2)
- Subendometrial anechoic cysts,
which represent small dilated ectopic endometrial glands (Fig.2)
- Subendometrial hyperechoic lines or buds which cross the junctional zone (Fig.3)
- Subendometrial hyperechoic islands,
which represent ectopic endometrial tissue (Fig.4)
- Translesional vascularity
- Irregular or interrupted junctional zone.
Diagnosis of adenomyosis in case of one or more of the following positive criteria was established by MRI (6,7,8):
- Increased thickness of the junctional zone (≥ 12 mm) or a difference between the max and the min thickness of the junctional zone in both anterior and posterior portions of the uterus > 5 mm (Fig.5)
- Hypointense areas with ill-defined margins that extend into the myometrium from the junctional zone (Fig.6)
- Diffuse asymmetry of the myometrium with cystic-like foci within it (Fig.7)
- Hemorrhagic foci withinh myometrium (Fig.8).
Diagnostic performance indicators with 95% CI were firstly calculated for the whole cohort and then stratifying women by the presence or absence of associated leiomyomas or congenital uterine anomalies.
All statistical analysis were performed using "Software R - version 3.5.0" and "Software STATA 14.2".