Atri M, Reinhold C, Mehio A R, Chapman W B, Bret P M
Department of Radiology, McGill University, Montreal General Hospital, Quebec, Canada.
Radiology. 2000 Jun;215(3):783-90. doi: 10.1148/radiology.215.3.r00jn06783.
To evaluate the accuracy of ultrasonographic (US) features of adenomyosis by correlating them with histologic findings and to assess inter- and intraobserver agreement.
US was performed and videotaped in 102 consecutive hysterectomy specimens in a water bath. Videotapes were reviewed initially by two independent radiologists blinded to the clinical and histologic findings and after 1 month by one of the two; US and histologic findings were correlated. Features evaluated included diffuse abnormal echotexture of myometrium, subendometrial myometrial cysts, subendometrial echogenic nodules, subendometrial echogenic linear striations, nodular endometrial-myometrial junction, poor definition of the endometrial-myometrial junction, asymmetric thickness of the anteroposterior wall of the myometrium, and globular configuration.
The prevalence of adenomyosis in this cohort was 29.4% (30 of 102 specimens). The mean sensitivity, specificity, negative predictive value, positive predictive value (PPV), and accuracy for the diagnosis of adenomyosis for the three reviews were 81%, 71%, 90%, 54%, and 74%, respectively. All findings evaluated, except for nodular endometrial-myometrial junction, were significantly more common in uteri with adenomyosis (P <.05). Heterogeneous myometrium reached borderline significance (P =.05). The specificities and PPVs of subendometrial striations, subendometrial echogenic nodules, and asymmetric myometrial thickness were significantly higher than those of other features (P <.05). The interobserver agreement was moderate (kappa = 0.48), and the intraobserver agreement was good (kappa = 0. 67) for the three reviews.
The presence of subendometrial linear striations, subendometrial echogenic nodules, or asymmetric myometrial thickness improves the specificity and PPV of US in diagnosing adenomyosis.
通过将子宫腺肌病的超声（US）特征与组织学结果相关联，评估其准确性，并评估观察者间和观察者内的一致性。
对102例连续的子宫切除标本在水浴中进行超声检查并录像。录像最初由两名对临床和组织学结果不知情的独立放射科医生进行评估，1个月后由其中一名医生再次评估；将超声和组织学结果进行关联。评估的特征包括肌层弥漫性异常回声、子宫内膜下肌层囊肿、子宫内膜下高回声结节、子宫内膜下高回声线性条纹、结节状子宫内膜-肌层交界、子宫内膜-肌层交界界限不清、肌层前后壁不对称厚度以及球形结构。
该队列中子宫腺肌病的患病率为29.4%（102例标本中的30例）。三次评估诊断子宫腺肌病的平均敏感性、特异性、阴性预测值、阳性预测值（PPV）和准确性分别为81%、71%、90%、54%和74%。除结节状子宫内膜-肌层交界外，所有评估的结果在患有子宫腺肌病的子宫中明显更常见（P <.05）。肌层不均匀达到临界显著性（P =.05）。子宫内膜下条纹、子宫内膜下高回声结节和肌层不对称厚度的特异性和PPV显著高于其他特征（P <.05）。三次评估的观察者间一致性为中等（kappa = 0.48），观察者内一致性良好（kappa = 0.67）。
子宫内膜下线性条纹、子宫内膜下高回声结节或肌层不对称厚度的存在提高了超声诊断子宫腺肌病的特异性和PPV。
