Transvaginal ultrasound versus magnetic resonance imaging for diagnosing adenomyosis: A systematic review and head‐to‐head meta‐analysis

Alcázar, Juan Luis; Vara, J.; Usandizaga, Claudia; Ajossa, Silvia; Pascual, M.; Guerriero, S.

doi:10.1002/ijgo.14609

Cited by 7 publications

(4 citation statements)

References 22 publications

(55 reference statements)

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“…Another common problem in the recruitment of patients with adenomyosis lies in the confirmation of the diagnosis. Although, classically, diagnoses have been based on a pathological confirmation, thanks to advances in ultrasound and MRI, very accurate diagnoses can now be made without the need for surgery [ 19 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…Some meta-analyses that analyzed these studies reported that the sensitivity of ultrasound is 72–84%, and its specificity is 74–87% [ 15 , 16 ]. Several meta-analyses compared the diagnostic performance of transvaginal ultrasound with that of magnetic resonance imaging [ 17 , 18 , 19 , 20 ]. The conclusion of all these meta-analyses is that ultrasound offers similar diagnostic performance to MRI.…”

Section: Introductionmentioning

confidence: 99%

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Adenomyosis in Pregnancy—Should It Be Managed in High-Risk Obstetric Units?

et al. 2023

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Background: Uterine adenomyosis is an increasingly frequent disorder. Our study aimed to demonstrate the presence of obstetric complications in the population affected by this condition to demonstrate the need for follow-up in high-risk obstetric units. Material and Methods: The data for the study were obtained from TriNetX, LLC, between 2010 and 2020. The outcomes analyzed were intrauterine growth restriction (IUGR), preterm delivery, cesarean delivery, hypertension, abruption placentae, and spontaneous abortion. Seven thousand six hundred and eight patients were included in the cohort of pregnant patients with adenomyosis, and 566,153 women in the cohort of pregnant patients without any history of endometriosis. Results: Upon calculating the total risk of presenting any of these problems during pregnancy, we obtained an OR = 1.521, implying that a pregnancy with adenomyosis was 52.1% more likely to present some complication. We found: IUGR OR = 1.257 (95% CI: 1.064–1.485) (p = 0.007); preterm delivery OR = 1.422 (95% CI: 1.264–1.600) (p = 0.0001); cesarean delivery OR = 1.099 (95% CI: 1.002–1.205) (p = 0.046); hypertensive disorders OR = 1.177 (95% CI: 1.076–1.288) (p = 0.0001); abruption placentae OR = 1.197 (95% CI: 1.008–1.422) (p = 0.040), and spontaneous abortion OR = 1.529 (95% CI: 1.360–1.718) (p = 0.0001). Conclusion: We conclude that the review carried out and the data we obtained on increased risk provide sufficient evidence to recommend that patients with adenomyosis should be managed in obstetric high-risk units.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Adenomyosis in Pregnancy—Should It Be Managed in High-Risk Obstetric Units?

et al. 2023

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“…A recent meta-analysis showed that MRI and TVS had an adequate performance with regard to diagnosing adenomyosis, with a pooled sensitivity and specificity of 75% and 81% for TVS and 69% and 80% for MRI, p = 0.75, when hysterectomy was used as a gold standard [ 30 ]. Still, both modalities have shown unsatisfactory inter-rater agreement for the diagnosis, indicating that adenomyosis is challenging even for experts.…”

Section: Discussionmentioning

confidence: 99%

Inter-Rater Agreement for Diagnosing Adenomyosis Using Magnetic Resonance Imaging and Transvaginal Ultrasonography

et al. 2023

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Our aim was to compare the inter-rater agreement about transvaginal ultrasonography (TVS) with magnetic resonance imaging (MRI) with regard to diagnosing adenomyosis and for assessing various predefined imaging features of adenomyosis, in the same set of women. The study cohort included 51 women, prospectively, consecutively recruited based on a clinical suspicion of adenomyosis. MRIs and TVS videoclips and 3D volumes were retrospectively assessed by four experienced radiologists and five experienced sonographers, respectively. Each rater subjectively evaluated the presence or absence of adenomyosis, as well as imaging features suggestive of adenomyosis. Fleiss kappa (κ) was used to reflect inter-rater agreement for categorical data, and the intraclass correlation coefficient (ICC) was used to reflect the reliability of quantitative data. Agreement between raters for diagnosing adenomyosis was higher for TVS than for MRI (κ = 0.42 vs. 0.28). MRI had a higher inter-rater agreement in assessing wall asymmetry, irregular junctional zone (JZ), and the presence of myometrial cysts, while TVU had a better agreement for assessing globular shape. MRI showed a moderate to good reliability for measuring the JZ (ICC = 0.57–0.82). For TVS, the JZ was unmeasurable in >50% of cases, and the remaining cases had low reliability (ICC = −0.31–0.08). We found that inter-rater agreement for diagnosing adenomyosis was higher for TVS than for MRI, despite the fact that MRI showed a higher inter-rater agreement in most specific features. Measurements of JZ in the coronal plane with 3D TVS were unreliable and thus unlikely to be useful for diagnosing adenomyosis.

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“… 9 Further, the use of three‐dimensional (3D) ultrasound has enabled an enhanced visualization of the junctional zone (JZ), which may improve the diagnostic accuracy. 10 An improved agreement between different diagnostic modalities without the need for hysterectomy 10 , 11 , 12 has enabled studies on the prevalence of adenomyosis, which ranges from 5% to 70%. 13 , 14 Heterogeneity in study design and different criteria used to describe adenomyosis could explain some of these variations.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of adenomyosis features in women scheduled for assisted reproductive treatment, using the Morphological Uterus Sonographic Assessment group definitions

Alson,

Jokubkiene,

Henic

et al. 2024

Acta Obstet Gynecol Scand

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IntroductionStudies that use standardized ultrasonographic criteria to diagnose adenomyosis in subfertile women are needed. These would improve the understanding of the disease burden and enable further studies on its impact on fertility and assisted reproductive treatment (ART) outcome. The aim of this study was to determine the prevalence of different features of adenomyosis in women scheduled for their first ART, diagnosed at two (2D) and three‐dimensional (3D) transvaginal ultrasonography (TVUS) using the revised Morphological Uterus Sonographic Assessment (MUSA) group definitions.Material and methodsThis was a prospective, observational cross‐sectional study of subfertile women aged 25 to ≤39 years, that were referred to a university hospital for their first ART between December 2018 and May 2021. Of 1224 eligible women, 1160 women fulfilled the inclusion criteria and consented to participate in the study. All women underwent a systematic 2D and 3D TVUS examination. The primary outcome was the presence of direct and indirect features of adenomyosis, as proposed by the MUSA group. Secondary outcomes were to describe the ultrasonographic characteristics of the different features, as well as any difference in the diagnostics at 2D or 3D TVUS and any association with clinical characteristics such as endometriosis.ResultsAt least one direct or indirect feature of adenomyosis was observed in 272 (23.4%, 95% confidence interval [CI] 21.0–25.9) women. Direct features that are pathognomonic for the disease were observed in 111 (9.6%, 95% CI, 7.9–11.3) women. Direct features were visible only at 3D TVUS in 56 (4.8%, 95% CI 3.6–6.1) women, that is, 56/111 (50.5%) of women with at least one direct adenomyosis feature. Direct features were more common in women with endometriosis (OR 2.8, 95% CI 1.8–4.3).ConclusionsWe found than one in 10 women scheduled for ART had direct features of adenomyosis at ultrasound examination. The present study suggests that the use of 3D TVUS is an important complement to 2D in the diagnostics of adenomyosis. Our results may further improve the counseling of women scheduled for ART and enables future studies on the impact of different features of adenomyosis on subfertility, ART results and obstetric outcomes.

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Transvaginal ultrasound versus magnetic resonance imaging for diagnosing adenomyosis: A systematic review and head‐to‐head meta‐analysis

Cited by 7 publications

References 22 publications

Adenomyosis in Pregnancy—Should It Be Managed in High-Risk Obstetric Units?

Adenomyosis in Pregnancy—Should It Be Managed in High-Risk Obstetric Units?

Inter-Rater Agreement for Diagnosing Adenomyosis Using Magnetic Resonance Imaging and Transvaginal Ultrasonography

Prevalence of adenomyosis features in women scheduled for assisted reproductive treatment, using the Morphological Uterus Sonographic Assessment group definitions

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