Three-dimensional transvaginal ultrasonographic and power Doppler features of adenomyosis : Are they related to symptoms?

Aim of the work: To investigate the relationship between specific 2D and 3D ultrasound and power Doppler features of adenomyosis and the commonly associated adenomyosis symptoms in absence of other pelvic pathologies.
Patients and Methods: This is a prospective observational study done at the Obstetrics and Gynecology Ultrasound Unit, Zagazig University Hospitals. This study was carried out from September 2015 to February 2017. It included all premenopausal women complaining of abnormal uterine bleeding, pain, subfertility and others. Cases without ultrasound detected pathology were collected as a control group (273), while cases having only adenomyosis ultrasonographic features by 2D-transvaginal sonography were collected as adenomyosis group (148). 2D-TVS myometrial assessment was performed for all women. 3D-TVS was then performed for full visualization of the junctional zone. VOCAL was used to calculate the Doppler indices of the myometrium.
Results: The number of ultrasound findings was independent predictor for occurrence of menstrual disorders and chronic pelvic pain. Junctional zone irregularity was a predictor for heavy menstruation and chronic pelvic pain, increased uterine volume and asymmetry were significantly correlated with chronic pelvic pain, while subfertility might be predictable with fan shaped shadowing and myometrial cysts. All myometrial Doppler indices were significantly higher in adenomyotic cases compared to control group. Increased myometrial VI and VFI were strongly correlated with the occurrence of heavy menstruation and inter-menstrual bleeding.
Conclusion: We found a relationship between certain ultrasound features of adenomyosis and some of associated symptoms. This relationship can help in understanding the pathophysiology of symptoms related to adenomyosis.