Real-time elastography for assessment of uterine disorders

Sonoelastography is an ultrasound-imaging technique that measures tissue strain. The aim of this study was to define, in a systematic manner, specific sonoelastographic characteristics of the myometrium, fibroids and adenomyosis, to evaluate the feasibility of sonoelastography in patients with suspected gynecological pathology and to compare the results with histology and/or magnetic resonance imaging (MRI)-based diagnoses.

We performed a prospective observational cohort study between 2009 and 2011. Two-hundred and eighteen women with suspected gynecological pathology underwent routine transvaginal ultrasound and additional real-time sonographic elastography. Sixty-nine of the 218 women underwent MRI and/or histological examination and were included in the final analysis. Acquisition of elastographic images was standardized. We analyzed the elastographic characteristics of myometrium, fibroids and adenomyosis. An independent observer, unaware of clinical, histological or MRI findings, evaluated the recorded elastographic images and cineloops. These elastographic-based diagnoses were compared with histology and/or MRI diagnoses.

With elastography, the uterus was well delineated from the surrounding bowel. The myometrium was uniform in color in 49% of the cases, with a main color of purple or dark blue, indicating stiffer tissue. Fibroids and adenomyosis had different elastographic characteristics and different color patterns. In general, fibroids were darker and adenomyosis was brighter than adjacent myometrium. The agreement between elastography-based diagnosis of fibroids and adenomyosis with MRI-based diagnosis was excellent; with histology-based diagnosis, agreement was substantial for fibroids and adenomyosis.

Elastography is able to identify clear discriminating characteristics of the uterus, fibroids and adenomyosis, and elastography-based diagnoses are in excellent agreement with those of MRI. Agreement between elastography-based diagnosis of adenomyosis and histology is substantial but not optimal.