The value of shear wave elastography, transvaginal ultrasound and magnetic resonance imaging in the diagnosis of adenomyosis

Objective : Our objective is to compare the value to transvaginal ultrasound, magnetic resonance imaging and shear wave elastography in terms of adenomyosis and uterine myoma differential diagnosis. Setting: Academic tertiary center Methods and Materials: In this prospective cohort study, the patients who applied to the Gynecology and Infertility Outpatient Clinic in Istanbul University Faculty of Medicine between October 2018 and October 2021 due to abnormal uterine bleeding, pelvic pain, infertility were evaluated. The patients who were diagnosed with adenomyosis and uterine myoma according to clinical evaluation were included and grouped. Clinical diagnosis were confirmed with contrast enhanced pelvic magnetic resonance imaging. No histopathological confirmation were included in this study. 34 patients were included in adenomyosis group and 31 patients were included in myoma group. All patients were evaluated with shear wave elastography; 3 regions of interest were selected for each elastographic evaluation. Average shear values were determined automatically; then, minimum and maximum mean shear values were recorded accordingly. Elastography values of both groups were compared in order to detect any statistically significant difference between 2 groups. In addition to elastography evaluation, the compatibility of transvaginal ultrasound and magnetic resonance were evaluated. Findings: No significant difference was detected between 2 groups in terms of descriptive characteristics of patient. The minimum mean shear value of the patients in fibroid grup was statistically significant and higher compared to the ones in adenomyosis group. (31.59 vs 25.04 ,p=0.047). No significant difference was seen between the maximum mean shear values ​​of the both groups. (50.81 vs. 48.16 p>0.05). The ROC curve was created for the minimum mean shear value in adenomyosis diagnosis. (AUC: 0.66) and the cut-off point was set as >23.7% (sensitivity 80.65%, specificity 55.88%) as minimum mean shear value in terms of adenomyosis diagnosis. A significant correlation was drawn between MRI and TVUS imaging (kappa:0.96 CI 0.9-1.0). The sensitivity and specifity of TVUS were determined as 100% and 96.8% and positive predictive value was determined as %97.1 for adenomyosis group. Conclusions: On the contrary of maximum mean shear values, the minimum mean shear values of adenomyosis and myoma group were statistically significant. In order to clearly discriminate these two pathologies with the use of shear wave elastography, future studies with higher number of participants should be established. Keywords: Shear wave elastography, transvaginal ultrasonography, magnetic resonance imaging, adenomyosis, fibroid