Contrast-enhanced ultrasound imaging in the diagnosis of adenomyosis

Objective. To identify the most informative qualitative and quantitative diagnostic criteria for adenomyosis according to the data of transvaginal contrast-enhanced ultrasound (TV CEUS). Materials and methods. Forty-eight patients (a study group) with adenomyosis and 36 women (a control group) with the unchanged myometrium were examined. All the patients underwent TV CEUS using the ultrasound contrast agent (USCA) SonoVue. The investigation was conducted in the V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia, in 2018-2019. Results. There were differences in the qualitative parameters of TV CEUS of the myometrium in health and adenomyosis in terms of the intensity and homogeneity of enhancement, the rate and type of contrasting, and the uniformity of USCA washout. The best diagnostic informative value indicators of adenomyosis are heterogeneous contrasting (sensitivity - 100%, specificity - 83.33%, and AUC - 0.917), uneven washout (sensitivity - 85.42%, specificity - 83.33%, and AUC - 0.844), slow accumulation (sensitivity - 81.25%, specificity - 88.89%, and AUC - 0.851), and low contrasting (sensitivity - 72.92%, specificity - 88.89%, and AUC - 0.809). There were differences between the groups in the quantitative parameters of TTR, PI, AT, AS, and DS. With a threshold value of TTP > 19.52s, sensitivity, specificity, andAUC were 87.0%, 83.3%, and 0.895, respectively; with a threshold value of PI < 36.1 dB, these were 95.7%, 83.3%, and AUC 0.941. Conclusion. TV CEUS revealed the most informative qualitative and quantitative diagnostic criteria for adenomyosis.

ultrasound imaging, myometrium, adenomyosis, contrast enhancement, echo-contrast agent