[A STUDY OF UTERINE HEMODYNAMICS USING THREE-DIMENSIONAL POWER DOPPLER SONOGRAPHY IN PATIENTS WITH ADENOMYOSIS]

The goal of the work was the investigation of volumetric blood flow parameters in uterine body of women of different ages suffering from various forms of adenomyosis, in three-dimensional angio mode, in order to search for objective differential-diagnostic criteria of this pathology. The main study group included 46 women aged 18 to 45 who were diagnosed with II-III degree adenomyosis at ultrasound examination of pelvic organs according to the conventional procedure in a two-dimensional mode. The control group included 111 healthy women aged 18 to 45 years old. A study of hemodynamics of the uterine body of women of both groups was carried out in three-dimensional angiography mode using the energy mapping function and VOCAL (Virtual Organ Computer-Aided Analysis) option by calculating the vascularization index (VI), which characterizes the percentage ratio of blood vessels in a certain tissue volume, blood flow index (FI), characterizing the intensity of blood flow, showing the volume of blood cells moving in vessels at the examination time, and vascularization flow index (VFI), which is an indicator of organ perfusion. As a result, it has been established that volumetric blood flow parameters in women of the main group and the control group preserved statistically significant dynamics of changes depending on the menstrual cycle phases: their values were minimum at menstrual cycle early proliferative phase, reaching their maximum by the medium secretory phase due to corpus luteum maturation in the ovary, and decreasing by late secretory phase. No significant differences in VI, FI, VFI parameters of the uterine body in women with different types of adenomyosis were found. Significant differences have been established in uterine perfusion of women with adenomyosis in combination with uterine leiomyoma in the form of an increase in vascularization parameters compared with an isolated form of adenomyosis. However, despite this, they were all significantly lower than in the control group, and this applies to both isolated form of adenomyosis and adenomyosis in combination with leiomyoma. The obtained data confirm the characteristic hypovascularization of the myometrium of patients with adenomyosis and allow using the three-dimensional power Doppler sonography technique for the diagnostics of adenomyosis. The reduction of parameters VI, FI, VFI in assessment of uterine hemodynamics compared with the volumetric vascularization parameters of healthy women can be used as an objective differential-diagnostic criterion for this pathology. The obtained results of the study of volumetric blood flow parameters (VI, FI, VFI) of the uterus of women with isolated adenomyosis of various forms and adenomyosis in combination with uterine leiomyoma would allow, on the first part, to improve the accuracy of ultrasound diagnostics of adenomyosis based on a significant decrease in these parameters compared to those of healthy women. On the second part, they will significantly increase the level of differential diagnostics between the nodular form of adenomyosis and the uterine nodular leiomyoma based on the diagnostics of myometrial hypovascularization in adenomyosis. On the third part, a decrease in the values of the studied parameters compared to the normal values in women with uterine leiomyoma is indicative of a combination of leiomyoma with adenomyosis.