Sonographic Signs of Adenomyosis Are Prevalent in Women Undergoing Surgery for Endometriosis and May Suggest a Higher Risk of Infertility

Vered H Eisenberg, Nissim Arbib, Eyal Schiff, Motti Goldenberg, Daniel S Seidman, David Soriano, Vered H Eisenberg, Nissim Arbib, Eyal Schiff, Motti Goldenberg, Daniel S Seidman, David Soriano

Abstract

Objectives: To determine the prevalence of ultrasound features suggestive of adenomyosis in women undergoing surgery for endometriosis compared with a control group of healthy women without endometriosis.

Methods: Retrospective case-control study comparing women with intractable pain or infertility, who underwent transvaginal ultrasound and subsequent laparoscopic surgery, with a control group of healthy women without a previous history of endometriosis. A diagnosis of adenomyosis on TVUS was made based on asymmetrical myometrial thickening, linear striations, myometrial cysts, hyperechoic islands, irregular endometrial-myometrial junction, parallel shadowing, and localized adenomyomas and analyzed for one sign and for three or more signs.

Results: The study and control groups included 94 and 60 women, respectively. In the study group, women were younger and had more dysmenorrhea and infertility symptoms. The presence of any sonographic feature of adenomyosis, as well as three or more signs, was found to be more prevalent in the study group, which persisted after controlling for age, for all features but linear striations. Women in the study group who had five or more sonographic features of adenomyosis had more than a threefold risk of suffering from infertility (OR = 3.19, p = 0.015, 95% CI; 1.25-8.17). There was no association with disease severity at surgery.

Conclusions: Sonographic features of adenomyosis are more prevalent in women undergoing surgery for endometriosis compared to healthy controls. Women with more than five features had an increased risk of infertility.

Figures

Figure 1
Figure 1
Parallel shadowing. 2D image in transverse view of a uterus with parallel hypoechoic lines through the myometrium (arrow).
Figure 2
Figure 2
Asymmetrical myometrial thickening. 2D longitudinal view of a uterus with asymmetrical distances from the endometrium to the anterior and posterior serosal surfaces (arrows).
Figure 3
Figure 3
Severe adenomyosis with multiple sonographic signs: multiplanar and 3D rendering of an anteverted uterus with multiple sonographic signs: myometrial cysts (white arrow), hyperechoic islands (yellow arrow), linear striations (green arrow), and irregular EMJ (black arrow).
Figure 4
Figure 4
Localized adenomyoma. 2D image of an anteverted uterus with a localized adenomyoma in the posterior fundal wall (between yellow arrows).

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