ADENOMYOSIS ULTRASOUND FINDINGS IN PATIENTS WITH

PREVIOUSLY KNOWN ENDOMETRIOSIS

Mariona Rius, Cristina Ros, Jordina Munrós, María Ángeles Martínez-Zamora, María José Martínez-Serrano, Juan Balasch, Francisco Carmona.

Hospital Clinic, Barcelona. Spain

Background…

•  Miometrial invasion by endometrial glands. •  Local inflammatory response.

•  Two types of adenomyosis: focal vs difuse.

•  Transvaginal scan and MRI high levels of accurancy in diagnosis of adenomyosis.

Prevalence

•  20.9% women who consult in a gyneacology clinic. •  Associated to:

–  Age. –  Parity. –  Endometriosis.

Prevalence (II)

•  152 patients with endometriosis: –  56.8%: no adenomyosis associated. –  42.8%: with adenomyosis associated.

DISMENORREA

DISPAREUNIA

Objective

Describe the adenomyosis ultrasound findings and its relation with different locations of endometriosis in patients with previously known endometriosis.

Study design

•  Transvaginal ultrasound scan in 166 patients.

•  Endometriosis Unit in our hospital.

•  Adenomyosis criteria:

Myometrial heterogeneity

Asimetric walls

Myometrial cysts

Ecogenic linear striations

Infiltration of juctional zone

Study design

•  Transvaginal ultrasound scan in 166 patients.

•  Endometriosis Unit in our hospital.

•  Adenomyosis criteria: -  Mild ≤ 2 criteria. -  Severe > 2 criteria.

Mild adenomyosis

Severe adenomyosis

Study design

•  Endometriosis: – Ovarian endometrioma. – Tube affection. – Bladder endometriosis. – Rectovaginal wall endometriosis. – Uterosacral ligament endometriosis. – Kissing ovaries. – Rectosigmoid endometriosis. – Retrouterine endometriosis.

Retrouterine endometriosis

Rectosigmoid endometriosis

Kissing ovaries

Results

Mild adenomyosis (n=35)

Severe adenomyosis (n= 66)

p

Endometrioma (R/L) 14/10 30/28 ns Tube affection (R/L) 10/4 18/12 ns Bladder endometriosis 2 0 ns Rectovaginal wall endometriosis

4 4 ns

Uterosacral ligament endometriosis (R/L)

14/8 22/12 ns

Kissing ovaries + rectosigmoid

0 13 < 0.021

Retrouterine endometriosis 7 26 < 0.024

Conclusions

Severe adenomyosis is associated with endometriosic retrouterine blockage.