Ultrasound Elastography for the Diagnosis of Endometriosis and Adenomyosis: A Systematic Review with Meta-analysis

Brunelli, Ana Claudia; Brito, Luiz Gustavo Oliveira; Moro, Flavia Assad Salum; Jales, Rodrigo Menezes; Yela, Daniela Angerame; Benetti‐Pinto, Cristina Laguna

doi:10.1016/j.ultrasmedbio.2022.11.006

Cited by 7 publications

(5 citation statements)

References 42 publications

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“…Although the classification system was relatively comprehensive and showed good interobserver agreement, it did not incorporate the elastography findings and may not be convenient for clinical application. Our results and those of some previous studies have demonstrated the value of elastography in diagnosing and assessing the severity of endometriosis and adenomyosis [ 6 , 11 , 21 – 23 ]. Elastography is also valuable in evaluating the efficacy of conservative treatment.…”

Section: Discussionsupporting

confidence: 83%

“…Elastography, as an emerging imaging technique, can objectively reflect tissue stiffness. A positive correlation between tissue stiffness assessed by elastography and the degree of fibrosis has been reported [ 11 ]. Elastography could be mainly divided into two categories: stain imaging and shear-wave imaging.…”

Section: Introductionmentioning

confidence: 99%

“…Elastography could be mainly divided into two categories: stain imaging and shear-wave imaging. The tissue response to mechanical stimuli is used to quantify the tissue stiffness in both approaches [ 9 , 11 ]. Elastography has proven useful in assessing the extent of tissue fibrosis and diagnosing benign and malignant diseases in the liver, breast, and other organs [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

“…Lesion stiffness in both adenomyosis and deep infiltrating endometriosis is stiffer than in adjacent normal tissues. It is reported that elastography may be promising in diagnosing and characterizing pelvic endometriotic lesions and adenomyosis [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Application of elastography to diagnose adenomyosis and evaluate the degree of dysmenorrhea: a prospective observational study

Ren,

Dong,

Yuan

et al. 2023

Reprod Biol Endocrinol

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Background To determine whether there is a correlation between stiffness measured by strain elastography and the severity of dysmenorrhea and to determine the value of elastography in evaluating severe dysmenorrhea in patients with adenomyosis. Methods The correlation between tissue stiffness and dysmenorrhea was analyzed by performing elastography on premenopausal women diagnosed with adenomyosis. Expression levels of transforming growth factor-β (TGF-β), α-smooth muscle actin (α-SMA), and protein gene product 9.5 (PGP9.5) were detected by immunohistochemistry; the correlation of TGF-β and α-SMA levels with the tissue stiffness and the degree of fibrosis was further analyzed. Also, the relationship of the PGP9.5 expression level with the tissue stiffness and degree of dysmenorrhea was determined. Results The degree of dysmenorrhea was significantly positively correlated with lesion stiffness in patients with adenomyosis but not with the uterine or lesion volume. The cutoff for the strain ratio was > 1.36 between the adenomyosis and control groups, with an area under the curve (AUC) of 0.987. For severe dysmenorrhea, the cutoff for the strain ratio was > 1.65 in patients with adenomyosis, with an AUC of 0.849. TGF-β, α-SMA, and PGP9.5 expression levels were higher in adenomyotic lesions than in the endometrium of the adenomyosis and control groups. Both TGF-β and α-SMA levels were positively correlated with the tissue stiffness and degree of fibrosis. Additionally, the expression level of PGP9.5 showed a positive correlation with the tissue stiffness and degree of dysmenorrhea. Conclusions Elastography can be used to evaluate the degree of dysmenorrhea; the greater the tissue stiffness, the greater the degree of dysmenorrhea. In addition, elastography performed well in the diagnosis of adenomyosis and the evaluation of severe dysmenorrhea in patients with adenomyosis.

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Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Application of elastography to diagnose adenomyosis and evaluate the degree of dysmenorrhea: a prospective observational study

Ren,

Dong,

Yuan

et al. 2023

Reprod Biol Endocrinol

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“…Xholli et al discuss the utilization of elastography, a technology with the ability to quantitatively assess tissue structure and elasticity, in the identification or the monitoring of the progression of established DIE nodules [28]. Brunelli et al emphasize the significant role of elastography in the accurate diagnosis of deep pelvic endometriosis lesions, exhibiting high sensitivity and specificity [29].…”

Section: Discussionmentioning

confidence: 99%

Transvaginal Ultrasound vs. Magnetic Resonance Imaging: What Is the Optimal Imaging Modality for the Diagnosis of Endometriosis?

Baușic,

Matasariu,

Manu

et al. 2023

Biomedicines

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Endometriosis, an intriguing gynecological illness, poses a substantial health concern for women of reproductive age, despite its widespread occurrence and limited comprehension. The objective of this study is to assess the diagnostic precision of transvaginal sonography (TVS) and pelvic magnetic resonance imaging (MRI) for the identification of deep infiltrated endometriosis (DIE). This study encompassed a cohort of 256 patients exhibiting signs and symptoms of endometriosis, with the aim of assessing the diagnostic accuracy over a span of four years. Both TVS and pelvic MRI were employed in the same centers to analyze each subject. The histopathologic analysis and laparoscopy were the most reliable and widely accepted methods for evaluation. TVS is a reliable diagnostic tool for ovarian endometriomas, obviating the necessity for MRI confirmation. The specificity of TVS in diagnosing ovarian endometriomas is 57.14%, while its sensitivity is 93.78%, resulting in an overall accuracy of 84.47%. In relation to parametrial lesions, the sensitivity, specificity, and accuracy of TVS and MRI were as follows: TVS: 9%, 97%, 32%, MRI: 27.14%, 89.19%, and 40.11%. Concerning the uterosacral lesions, the sensitivity, specificity, and accuracy of TVS and MRI were as follows: TVS:14.63%, 94.74%, and 55%, while MRI: 65.88%, 66.30%, and 66.1%. Regarding rectal endometriosis, the sensitivity, specificity, and accuracy of TVS and MRI were as follows: 69.72%, 76.87%, and 73.82% for TVS, and 66.28%, 94.51%, and 80.79% for MRI. The results of the present study indicate that whereas MRI generally exhibits superior capability in assessing the severity of endometriosis, TVS demonstrates sufficient diagnostic accuracy in DIE comparable to MRI.

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Can ultrasound elastography be useful in the diagnosis of poor ovarian response?

Gulec,

Gur,

Kurtulmus

et al. 2024

J of Clinical Ultrasound

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ObjectivesThis study aims to compare the elastographic properties of the ovaries of patients with poor ovarian response (POR) with healthy controls by using real‐time ultrasound tissue elastography and to investigate the predictive value of ovarian strain ratio (OSR) in the diagnosis of POR.Materials and MethodsA cross‐sectional study was conducted among infertility patients. OSR measurements of 46 women diagnosed with POR and 41 healthy controls with male infertility were performed by real‐time ultrasound tissue elastography. Ovarian volume, OSR, antral follicle count (AFC), age, body mass index (BMI), anti‐mullerian hormone (AMH), follicle stimulating hormone (FSH), and estradiol (E2) values, were compared between the groups. A receiver operating characteristic curve was used to compare the sensitivity and specificity of OSR, AFC, AMH, FSH, and E2 for POR diagnosis.ResultsPatients with POR were significantly older, had a lower duration of infertility, lower AMH, higher FSH, higher E2, lower AFC and ovarian volume (p < 0.01, p = 0.02, p < 0.01, p < 0.01, p < 0.01, p < 0.01, p < 0.01, respectively). The mean OSR of both ovaries was similar between the groups. For the diagnosis of POR, the sensitivity and specificity for AMH were 97.5% and 100%, for AFC were 86.7% and 97.6%; for FSH were 66.7% and 80.5%, for E2 were 53.3% and 90.2%, respectively.ConclusionsThe significant independent predictors of the POR were AMH, AFC, and FSH, with no additional significant contribution from OSR. However, considering the relationship between POR and ovarian fibrosis, it is recommended to investigate this issue in more comprehensive studies.

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Ultrasound Elastography for the Diagnosis of Endometriosis and Adenomyosis: A Systematic Review with Meta-analysis

Cited by 7 publications

References 42 publications

Application of elastography to diagnose adenomyosis and evaluate the degree of dysmenorrhea: a prospective observational study

Application of elastography to diagnose adenomyosis and evaluate the degree of dysmenorrhea: a prospective observational study

Transvaginal Ultrasound vs. Magnetic Resonance Imaging: What Is the Optimal Imaging Modality for the Diagnosis of Endometriosis?

Can ultrasound elastography be useful in the diagnosis of poor ovarian response?

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