New Diagnostic Tool For Women Suffering From Abnormal Vaginal Bleeding
New research from the Department of Radiology at Thomas Jefferson University Hospital suggests sonohysterography (SHG), a simple ultrasound technique commonly used to evaluate the uterine cavity, improves the diagnostic capability of transvaginal ultrasound in detecting adenomyosis (a common benign condition of the uterus that causes dysmenorrhea, abnormal vaginal bleeding and pelvic pain).
The study – set to be published in the April issue of the American Journal of Roentgenology – reveals an effective tool with a ‘new sign’ to diagnose adenomyosis; it is a safe alternative to immediate biopsy for women who present with abnormal vaginal bleeding and severe uterine and pelvic pain.
The study included 26 women who underwent sonohysterography and MRI of the pelvis and in whom either modality suggested adenomyosis. Of these 26 women, 23 (88 percent) had SHG findings suggestive of adenomyosis. Three remaining women (12 percent) had adenomyosis identified on MRI performed after sonohysterography. MRI confirmed adenomyosis in 22/23 patients (96 percent).
“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,” said Sachit Verma, M.D., lead author of the study. “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. This peculiar appearance was seen in one of our patients on MRI as well,” said Dr. Verma.
Patients often present with symptoms of abnormal bleeding, pelvic pain and infertility which may be due to a uterine fibroid, a polyp, tumor or adenomyosis. MR imaging is expensive and is not always available as a first line investigation to evaluate abnormal bleeding. In addition it is difficult to distinguish lesions in the uterus (myometrium and endometrium) using transvaginal ultrasound alone. SHG then has a role to play in managing these patients.
“Knowledge of ‘myometrial cracks’ will decrease the errors in interpretation and improve patient care so that specific treatment can be instituted,” he said. “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,” said Dr. Verma.