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Terms, definitions and measurements to describe sonographic features of myometrium and uterine masses: a consensus opinion from the Morphological Uterus Sonographic Assessment (MUSA) group
Van den Bosch, T.; Dueholm, M.; Leone, F. P. G. ...
Ultrasound in obstetrics & gynecology,
September 2015, Letnik:
46, Številka:
3
Journal Article, Conference Proceeding
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The MUSA (Morphological Uterus Sonographic Assessment) statement is a consensus statement on terms, definitions and measurements that may be used to describe and report the sonographic features of ...
the myometrium using gray‐scale sonography, color/power Doppler and three‐dimensional ultrasound imaging. The terms and definitions described may form the basis for prospective studies to predict the risk of different myometrial pathologies, based on their ultrasound appearance, and thus should be relevant for the clinician in daily practice and for clinical research. The sonographic features and use of terminology for describing the two most common myometrial lesions (fibroids and adenomyosis) and uterine smooth muscle tumors are presented. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
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Transvaginal sonographic features of diffuse adenomyosis in 18–30‐year‐old nulligravid women without endometriosis: association with symptoms
Pinzauti, S.; Lazzeri, L.; Tosti, C. ...
Ultrasound in obstetrics & gynecology,
December 2015, 2015-Dec, 2015-12-00, 20151201, Letnik:
46, Številka:
6
Journal Article
Recenzirano
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Objectives
To investigate whether there are sonographic features of diffuse adenomyosis in 18–30‐year‐old nulligravid women without endometriosis and to examine their association with symptoms of ...
dysmenorrhea and abnormal uterine bleeding.
Methods
This was a prospective observational study including women referred from a gynecology outpatient center to our university hospital for ultrasound examination. Inclusion criteria were age between 18 and 30 years, regular menstrual cycle and nulligravid status. Exclusion criteria were a past or current history of endometriosis, fibroids, ovarian cysts or lesions, endometrial pathology, current use of hormonal treatments or medications that would affect the menstrual cycle, previous uterine surgery and history of infertility. Women underwent a detailed clinical assessment and a two‐ (2D) and three‐dimensional (3D) transvaginal ultrasound (TVS) examination. 2D‐TVS features associated with diffuse adenomyosis were predefined as: (1) heterogeneous myometrium; (2) hypoechoic striation in the myometrium; (3) myometrial anechoic lacunae or cysts; (4) asymmetrical myometrial thickening of the uterine walls with the presence of straight vessels, extending into the hypertrophic myometrium, on power Doppler examination. On 3D‐TVS, endomyometrial junctional zone (JZ) was measured as the distance from the basal endometrium to the internal layer of the outer myometrium on coronal section at any level of the uterus, and the smallest (JZmin) and largest (JZmax) JZ thicknesses and their difference (JZdiff) were recorded. 3D‐TVS evaluation was considered suggestive for adenomyosis when JZmax ≥ 8 mm and/or JZdiff ≥ 4 mm. The presence of associated symptomatology represented our main outcome: the amount of menstrual loss was assessed by a pictorial blood loss analysis chart (PBAC) and painful symptoms were evaluated using a visual analog scale (VAS).
Results
During the observation period, 205 women (median age, 24 (interquartile range, 23–27) years) were enrolled into the study and 156 met the inclusion criteria. According to the 2D‐TVS criteria, diffuse adenomyosis was found in 53 (34.0%) women and asymmetrical myometrial thickening of the uterine walls was the most common sonographic feature observed. ANOVA showed a significant relationship between the number of 2D‐TVS features of diffuse adenomyosis and VAS score for dysmenorrhea (P = 0.005) as well as PBAC score for menstrual loss (P = 0.03). 3D‐TVS showed that women with 2D‐TVS features of diffuse adenomyosis had a significantly higher value of JZmax (6.38 ± 2.30 mm, P < 0.001), JZmin (2.07 ± 0.43 mm, P = 0.002) and JZdiff (4.33 ± 1.99 mm, P < 0.001) than did women without these features. Women with sonographic features of diffuse adenomyosis were symptomatic in 83% of cases, reported dysmenorrhea in 79.2% and showed a higher incidence of heavy bleeding than did those without these features (18.9% vs 2.9%; P = 0.001).
Conclusions
Sonographic features suggestive of diffuse adenomyosis may develop earlier in reproductive life than previously thought, and may occur in association with dysmenorrhea and abnormal uterine bleeding in nulligravid women. Their observation in these women should therefore warrant further gynecological investigation. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
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Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis, including terms, definitions and measurements: a consensus opinion from the International Deep Endometriosis Analysis (IDEA) group
Guerriero, S.; Condous, G.; van den Bosch, T. ...
Ultrasound in obstetrics & gynecology,
September 2016, Letnik:
48, Številka:
3
Journal Article
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ABSTRACT
The IDEA (International Deep Endometriosis Analysis group) statement is a consensus opinion on terms, definitions and measurements that may be used to describe the sonographic features of ...
the different phenotypes of endometriosis. Currently, it is difficult to compare results between published studies because authors use different terms when describing the same structures and anatomical locations. We hope that the terms and definitions suggested herein will be adopted in centers around the world. This would result in consistent use of nomenclature when describing the ultrasound location and extent of endometriosis. We believe that the standardization of terminology will allow meaningful comparisons between future studies in women with an ultrasound diagnosis of endometriosis and should facilitate multicenter research. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
Enfoque sistemático para la evaluación ecográfica de la pelvis en mujeres con posible endometriosis, incluyendo términos, definiciones y mediciones: una opinión consensuada del Grupo Internacional de Análisis de la Endometriosis Profunda
RESUMEN
La declaración del Grupo Internacional de Análisis de la Endometriosis Profunda (IDEA, por sus siglas en inglés) es una opinión basada en un consenso sobre los términos, definiciones y medidas que se pueden utilizar para describir las características ecográficas de los distintos fenotipos de la endometriosis. Actualmente es difícil comparar los resultados entre los estudios publicados porque los autores utilizan términos diferentes para describir las mismas estructuras y localizaciones anatómicas. Esperamos que los términos y definiciones propuestas en este documento se adopten en centros de investigación de todo el mundo. Esto resultaría en un uso uniforme de la nomenclatura para describir la ubicación y el alcance de la endometriosis en la evaluación ecográfica. Creemos que la normalización de la terminología permitirá realizar comparaciones significativas entre futuros estudios de mujeres con diagnóstico de endometriosis mediante ecografía y debería facilitar la investigación entre múltiples centros de investigación.
This article's has been translated into Spanish and Chinese. Follow the links from the to view the translations.
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Strengths and limitations of diagnostic tools for endometriosis and relevance in diagnostic test accuracy research
Pascoal, E.; Wessels, J. M.; Aas‐Eng, M. K. ...
Ultrasound in obstetrics & gynecology,
September 2022, Letnik:
60, Številka:
3
Journal Article
Recenzirano
Endometriosis is a chronic systemic disease that can cause pain, infertility and reduced quality of life. Diagnosing endometriosis remains challenging, which yields diagnostic delays for patients. ...
Research on diagnostic test accuracy in endometriosis can be difficult due to verification bias, as not all patients with endometriosis undergo definitive diagnostic testing. The purpose of this State‐of‐the‐Art Review is to provide a comprehensive update on the strengths and limitations of the diagnostic modalities used in endometriosis and discuss the relevance of diagnostic test accuracy research pertaining to each. We performed a comprehensive literature review of the following methods: clinical assessment including history and physical examination, biomarkers, diagnostic imaging, surgical diagnosis and histopathology. Our review suggests that, although non‐invasive diagnostic methods, such as clinical assessment, ultrasound and magnetic resonance imaging, do not yet qualify formally as replacement tests for surgery in diagnosing all subtypes of endometriosis, they are likely to be appropriate for advanced stages of endometriosis. We also demonstrate in our review that all methods have strengths and limitations, leading to our conclusion that there should not be a single gold‐standard diagnostic method for endometriosis, but rather, multiple accepted diagnostic methods appropriate for different circumstances. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Ultrasound features of highly vascularized uterine myomas (uterine smooth muscle tumors) and correlation with histopathology
Russo, C.; Camilli, S.; Martire, F. G. ...
Ultrasound in obstetrics & gynecology,
August 2022, 2022-08-00, 20220801, Letnik:
60, Številka:
2
Journal Article
Recenzirano
Objective
To correlate the ultrasound appearance of highly vascularized uterine myomas with their histopathological diagnosis.
Methods
This was a prospective observational study of patients with a ...
preoperative ultrasound diagnosis of a highly vascularized uterine myoma (color score of 3 or 4, according to the Morphological Uterus Sonographic Assessment (MUSA) criteria), characterized by circumferential and intralesional vascular pattern, who underwent myomectomy or hysterectomy. For each patient, ultrasound characteristics were recorded at baseline, including the number of lesions, the size, echogenicity and border regularity of the lesion, presence of cystic areas and shadowing within the myoma, and visualization of the endometrium. Ultrasound features were correlated with the definitive histological diagnosis. Ultrasound features were then compared between malignant and benign lesions.
Results
We included 70 patients with highly vascularized uterine myomas on power/color Doppler. Their mean age was 46.5 ± 11.4 years and 13 (18.6%) were postmenopausal. At histological examination, 65 (92.9%) uterine myomas were benign lesions, comprising 32 typical leiomyomas, 29 leiomyoma variants and four adenomyomas. The remaining five (7.1%) uterine myomas were malignant masses, comprising two uterine sarcomas, one leiomyosarcoma, one neuroendocrine tumor and one uterine smooth muscle tumor of uncertain malignant potential (STUMP). The mean age of patients with a malignant lesion was significantly higher than the age of those with a benign lesion (64.8 ± 16.0 vs 42.4 ± 5.1; P < 0.001). Four out of five patients with a malignant lesion were over 45 years old. Ultrasound demonstrated cystic areas within the lesion in 10/32 (31.3%) typical leiomyomas, 16/29 (55.2%) leiomyoma variants, all four adenomyomas and in the cases of STUMP and leiomyosarcoma. Lesion borders were regular in 64/65 (98.5%) benign lesions and 2/5 (40%) malignant lesions (P < 0.05). No significant differences were observed between benign and malignant lesions with respect to echogenicity, presence of shadowing and size. The endometrium was visible in 55/65 women with benign lesions and in 2/5 with malignant lesions (P = 0.03).
Conclusions
Our results showed that ultrasound features of uterine myomas, such as circumferential and intralesional vascularity, cystic areas and lesion borders, are important parameters for differential diagnosis, especially when combined with the patient's age. Such features could be useful to differentiate typical myomas from benign variants and malignant lesions in a preoperative setting and to select patients that may benefit from conservative management rather than surgery. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Adenomyosis: three‐dimensional sonographic findings of the junctional zone and correlation with histology
Exacoustos, C.; Brienza, L.; Di Giovanni, A. ...
Ultrasound in obstetrics & gynecology,
April 2011, Letnik:
37, Številka:
4
Journal Article
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Objective
To correlate with histopathological features the adenomyosis‐induced morphological alterations of the outer myometrium and the inner myometrium (‘junctional zone’, JZ) detectable on two‐ ...
(2D) and three‐dimensional (3D) transvaginal ultrasound imaging (TVS), and to evaluate their diagnostic accuracy for adenomyosis.
Methods
Premenopausal patients scheduled for hysterectomy for benign pathology were enrolled in this prospective study. Before hysterectomy all patients underwent detailed 2D‐TVS and 3D volume acquisition of the entire uterus. The major sonographic signs of adenomyosis were noted. On the multiplanar coronal and longitudinal views obtained by 3D‐TVS we measured the maximum and minimum JZ thickness from the basal endometrium to the internal layer of the outer myometrium (JZmax, JZmin), the difference between them (JZdif = JZmax − JZmin) and the ratio JZmax/total maximum myometrial thickness. Results of these examinations were correlated blindly to the presence of adenomyosis on histological specimens.
Results
A total of 72 premenopausal patients underwent 2D‐ and 3D‐TVS before hysterectomy. The histological prevalence of adenomyosis was 44.4% (32/72 patients). In diagnosing adenomyosis, the presence of myometrial cysts was the most specific 2D‐TVS feature (specificity, 98%; accuracy, 78%) and heterogeneous myometrium was the most sensitive (sensitivity, 88%; accuracy, 75%). The 3D‐TVS markers JZdif ≥ 4 mm and JZ infiltration and distortion had high sensitivity (88%) and the best accuracy (85% and 82%, respectively). For 2D‐TVS and 3D‐TVS, respectively, the overall accuracy for diagnosis of adenomyosis was 83% and 89%, the sensitivity was 75% and 91%, the specificity was 90% and 88%, the positive predictive value was 86% and 85% and the negative predictive value was 82% and 92%.
Conclusions
The coronal section of the uterus obtained by 3D‐TVS permits accurate evaluation and measurement of the JZ, and its alteration has good diagnostic accuracy for adenomyosis. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.
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