子宮腺筋症の超音波重症度を評価する新規半定量法と臨床症状との関連：観察研究

To correlate the sonographic severity of adenomyosis, assessed with real-time ultrasound and a novel semi-quantified method (XI-VOCAL counting and categories) with adenomyosis-associated symptoms.

This observational study was conducted in a tertiary referral outpatient clinic. We consecutively included 115 participants with ≥1 direct ultrasonographic adenomyosis feature; those with dominant myoma, malignancy, pelvic infection, pregnancy, breastfeeding, inadequate imaging, postmenopause, or hormonal medication use were excluded. A routine clinical protocol was followed for anamnestic and ultrasound data. Menstrual bleeding was assessed subjectively (three-point scale) and with a pictorial blood loss analysis chart (PBAC). Dysmenorrhea, dyspareunia, and chronic pelvic pain were evaluated using a numeric rating scale (NRS). A retrospective questionnaire was sent for missing items. Real-time severity was scored by experienced gynecologists. XI-VOCAL-based severity was assessed independently and blinded to clinical data, providing two severity scores: XI-VOCAL counting and XI-VOCAL categories. Correlations with symptoms were analyzed using Jonckheere-Terpstra, linear and logistic regression.

The real-time severity (severe vs mild) showed a strong correlation with adjusted PBAC (β 590.01, 95% CI 207.16-972.86, P < .01) and subjective blood loss assessment (OR 5.48, 95% CI 1.14-26.28, P < .05). Additionally, a strong correlation was found between XI-VOCAL counting and XI-VOCAL categories with adjusted PBAC score (XI-VOCAL counting: β 53.15, 95% CI 12.06-94.24, P < .05; XI-VOCAL categories (severe vs mild): β 627.36, 95% CI 165.92-1088.81, P < .05). No correlations were found with adjusted dysmenorrhea, chronic abdominal/pelvic pain, or dyspareunia.

Both real-time severity and XI-VOCAL-assessed severity correlate with adjusted PBAC scores and subjective blood assessment. XI-VOCAL appears more standardized, while real-time assessment may be influenced by symptom severity. Larger studies correcting for pain-related confounders are needed.