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Sonohysterography is an Alternative Diagnostic Tool for Women with Adenomyosis Suffering from Dysmenorrhea, Abnormal Vaginal Bleeding and Pelvic Pain

March 04, 2009

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), according to a study performed at the Thomas Jefferson University Hospital in Philadelphia, PA.

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%) had SHG findings suggestive of adenomyosis. Three remaining women (12%) had adenomyosis identified on MRI performed after sonohysterography. MRI confirmed adenomyosis in 22/23 patients (96%).

"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, MD, 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," said Dr. Verma.

"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.


The American Roentgen Ray Society (ARRS)