March 4, 2009 —Sonohysterography (SHG),
a simple ultrasound technique commonly used to evaluate the uterine cavity,
improves the diagnostic capability of transvaginal ultrasound in detecting
adenomyosis (a common benign condition of the uterus that causes dysmenorrhea,
abnormal vaginal bleeding and pelvic pain), according to a study performed at
the Thomas Jefferson University Hospital in Philadelphia, PA.
The study included 26
women who underwent sonohysterography and MRI of the pelvis and in whom either
modality suggested adenomyosis. Of these 26 women, 23 (88%) had SHG findings
suggestive of adenomyosis. Three remaining women (12%) had adenomyosis
identified on MRI performed after sonohysterography. MRI confirmed adenomyosis
in 22/23 patients (96%).
“This study describes
the presence of ill-defined areas of fluid intravasation extending from the
uterine cavity into the myometrium known as fluid containing tracks or so called
‘myometrial cracks’ on SHG,” said Sachit Verma, MD, lead author of the study.
“Myometrial cracks have not been described previously as a sign of adenomyosis.
The tracks, seen in 26% of our cases, become conspicuous as saline seeps through
the ‘myometrial cracks’. They are difficult to characterize on standard
transvaginal ultrasound. This peculiar appearance was seen in one of our
patients on MRI as well,” said Dr. Verma.
“Patients often present
with symptoms of abnormal bleeding, pelvic pain and infertility which may be due
to a uterine fibroid, a polyp, tumor or adenomyosis. MR imaging is expensive and
is not always available as a first line investigation to evaluate abnormal
bleeding. In addition it is difficult to distinguish lesions in the uterus
(myometrium and endometrium) using transvaginal ultrasound alone. SHG then has a
role to play in managing these patients,” said Dr. Verma.
‘myometrial cracks’ will decrease the errors in interpretation and improve
patient care so that specific treatment can be instituted,” he said. “This
additional information for the referring physician can possibly decrease the
number of endometrial biopsies—reducing costs in patient management—in cases
where SHG shows no uterine abnormality and adenomyosis is the sole cause of
abnormal bleeding,” said Dr. Verma.