Value of ultrasound shear wave elastography in the diagnosis of adenomyosis

Abstract

Background: The aim of the study was to assess the accuracy of ultrasound shear wave elastography in the diagnosis of adenomyosis.

Methods: One hundred and fifty three patients were examined. Ninety-seven patients were with suspected adenomyosis and 56 patients were with unremarkable myometrium. Adenomyosis was confirmed in 39 cases (A subgroup) and excluded in 14 cases (B subgroup) in the main group based on morphological examination. All patients underwent ultrasound examination using an Aixplorer (Supersonic Imagine, France) scanner with application of shear wave elastography during transvaginal scanning. Retrospective analysis of the elastography criteria against the findings from morphological/histological examination was performed.

Results: The following values of Young's modulus were found in subgroup A (adenomyosis): Emean - 72.7 (22.6-274.2) kPa (median, 5-95th percentiles), Emax - 94.8 (29.3-300.0) kPa, SD - 9.9 (2.6-26.3) kPa; in subgroup B (non adenomyosis) - 28.3 (12.7-59.5) kPa, 33.6 (16.0-80.8) kPa, 3.0 (1.4-15.6) kPa; in the control group - 24.4 (17.9-32.4) kPa, 29.8 (21.6-40.8) kPa, 2.3 (1.3-6.1) kPa, respectively (P < 0.05 for all comparison with subgroup В and the control group). The Emean cut-off value for adenomyosis diagnosis was 34.6 kPa. The sensitivity, specificity, positive predictive value, negative predictive value and area under curve (AUC) were 89.7%, 92.9%, 97.2%, 76.5% and 0.908. The Emax cut-off value was 45.4 kPa (89.7%, 92.9%, 97.2%, 76.5% and 0.907, respectively).

Conclusion: This study showed a significant increase of the myometrial stiffness estimated with shear wave elastography use in patients with adenomyosis.

Keywords: Ultrasound shear wave elastography; Young’s modulus; adenomyosis; stiffness.

Figures

Figure 1.

B-mode image of uterus with adenomyosis: heterogeneous myometrial echo texture; asymmetry of the anterior and posterior wall.

Figure 2.

Shear wave elastography of myometrium in a patient with confirmed adenomyosis (A subgroup). Grey-scale ultrasound in bottom row and overlaid shear wave elastography imaging in top row. Heterogeneous staining and high stiffness are demonstrated within a colour window (shear wave elastography imaging).

Figure 3.

Shear wave elastography of myometrium in a patient with confirmed adenomyosis (A subgroup) (ZOOM). Grey-scale ultrasound in bottom row and overlaid shear wave elastography imaging in top row. Colour window (shear wave elastography imaging) is characterized by heterogeneous staining. A wide range of Young’s modulus numerical values in three regions of interest (Q Box) are identified.

Figure 4.

Shear wave elastography of normal myometrium in a control group patient. Grey-scale ultrasound in bottom row and overlaid shear wave elastography imaging in top row. Colour window (shear wave elastography imaging) is characterized by homogenous staining. The results of Young’s modulus measurements in three regions of interest (Q-Box) are within the normal range.

Figure 5.

ROC curve of Emean in adenomyosis prediction. AUC was 0.908.

Figure 6.

ROC curve of Emax in adenomyosis prediction. AUC was 0.907.