(Ultrasound Review) Radiologists at the Cambridge Health Alliance in Cambridge, MA, studied the ultrasound findings in women with adenomyosis to assess whether certain ultrasound characteristics were indicative of the extent of adenomyosis. Also, they evaluated whether the presence of uterine fibroids altered diagnostic accuracy for adenomyosis, and whether the visibility of the endometrium was related to the severity of disease. Their findings were published in the American Journal of Roentgenology.
A diagnosis of adenomyosis was made using the surgical specimen after hysterectomy, and only patients that had ultrasound performed two months prior to surgery were included in the study. Ultrasound examination included evaluation of the endometrium, visualization of diffuse uterine changes, presence of fibroids, and normal appearances. These findings then were compared to the histology categories for adenomyosis, which included mild, focal, and severe adenomyosis.
Ultrasound was performed using both endovaginal and transabdominal approaches. Results demonstrated "46 specimens contained mild adenomyosis, 18 contained severe disease, and nine contained focal disease." Fibroids were found in 41 uterine specimens. They reported that "the endometrium was visualized in 10 cases of severe adenomyosis, seven cases of adenomyoma, and 35 cases of mild disease."
The severity of adenomyosis did not correlate with the visualization of the endometrium on ultrasound. Ultrasound showed diffuse uterine changes in 72% of cases with severe adenomyosis. There were nine adenomyomas and none of these displayed diffuse ultrasound changes, and only 19% of cases with mild adenomyosis had ultrasound characteristics of diffuse disease.
According to the authors "a diffuse process was related to the severity of adenomyosis," and "when fibroids were present, a diffuse process did not relate to the extent of adenomyosis." Their research showed that the presence of fibroids limited ultrasound accuracy in estimating the severity of adenomyosis, and that "the diagnosis of severe adenomyosis can be made when the sonographic features of a heterogeneous uterus with or without cystic spaces are present."
Sonographic findings in patients with adenomyosis: can sonography assist in predicting extent of disease?Hulka, C. A. et al,
Department of radiology, Cambridge Health Alliance, Cambridge, MA
AJR 2002 February; 179:379-383
By Ultrasound Review
September 4, 2002
Copyright © 2002 AuntMinnie.com
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&fit=crop&h=100&q=70&w=100)
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
