Sonohysterography Improves Diagnosis of Adenomyosis

According to a new study from the Thomas Jefferson University Hospital in Philadelphia, PA, the combination of sonohysterography with transvaginal ultrasound improves clinicians’ ability to diagnose adenomyosis. Adenomyosis is a common and benign condition of the uterus. It can cause abnormal vaginal bleeding, dysmenorrhea, and pelvic pain. American Journal of Roentgenology, the monthly journal of the American Roentgen Ray Society (AARS), is publishing study results in its April issue.

Sonohysterography, or SHG, is a technique which involves infusing a fluid, typically sterile saline, through the cervix into the uterus by way of a soft plastic catheter. The uterine cavity is distended by the infusion. The uterine lining is then easier to visualize, allowing for greater diagnostic specificity of uterine and endometrial pathology. The transvaginal ultrasound probe is inserted as usual.

The lead author of the study was Sachit Verma, M.D. The study included 26 women. According to Dr. Verma, “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. 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.”

Transvaginal ultrasound machines alone has been the first diagnostic tool used in cases where adenomyosis is suspected. When it fails to provide a diagnosis, an MRI is usually the next step. As Dr. Verma points out, MRIs are expensive and there may be a wait to get the patient scheduled. The combination of sonohysterography together with transvaginal ultrasound appears to provide as much diagnostic specificity as an MRI without the associated costs and delay. In the instant study, 23 women had findings suggestive of adenomyosis when SHG was used. Adenomyosis was confirmed in 22 of the 23 women using an MRI.

Dr. Verma said, “Knowledge of ‘myometrial cracks’ will decrease the errors in interpretation and improve patient care so that specific treatment can be instituted. 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.” This study provides further proof of the continued utility of ultrasound machine technology.

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