Brosens J J, de Souza N M, Barker F G, Paraschos T, Winston R M
Department of Obstetrics and Gynaecology, Hammersmith Hospital, London, UK.
Br J Obstet Gynaecol. 1995 Jun;102(6):471-4. doi: 10.1111/j.1471-0528.1995.tb11320.x.
To evaluate prospectively the role of endovaginal ultrasonography in the diagnosis of adenomyosis and to identify predictive characteristics.
In Vitro Fertilisation Unit, Hammersmith Hospital.
Fifty-six women with menorrhagia and dysmenorrhea.
Endovaginal sonography was performed and uterine body morphometry and myometrial echogenicity were assessed. The sonographic suspicion of adenomyosis was scored high or low depending on the degree of uterine enlargement, uterine asymmetry not due to fibroids and heterogenicity of myometrial echoes. The sonographic diagnosis was compared either with the histological findings after hysterectomy (n = 34) or to the appearances on magnetic resonance imaging (n = 22).
Adenomyosis was diagnosed in 28 patients: 15 by histology and 13 by magnetic resonance imaging. Endovaginal ultrasound demonstrated a sensitivity of 86%, a specificity of 50%, a positive predictive value of 86%, and a negative predictive value of 77%. Uterine morphometry alone did not predict adenomyosis: although the mean length of the longitudinal, anteroposterior and transverse axis was larger in uteri with, compared with those without, adenomyosis, this did not reach statistical significance. The uterine asymmetry ratio was 1.43 (SD 0.6) and 1.34 (SD 0.4) (P = 0.26) in uteri with and without adenomyosis, respectively, but in the presence of adenomyosis the mean posterior wall was significantly thicker than the mean anterior wall: 25.6 (SD 6.6) mm compared with 21.8 (SD 5.0) mm, P = 0.02. Therefore, adenomyosis was best predicted on the basis of ill-defined myometrial heterogeneity. However, leiomyomas and various echogenic shadows and artefacts often complicate subjective assessment of the myometrial echogenicity.
Endovaginal sonography in symptomatic patients can be a sensitive but not a specific procedure for the diagnosis of adenomyosis.
前瞻性评估经阴道超声检查在子宫腺肌病诊断中的作用，并确定预测特征。
伦敦哈默史密斯医院体外受精科。
56名有月经过多和痛经症状的女性。
进行经阴道超声检查，评估子宫体形态和肌层回声。根据子宫增大程度、非肌瘤导致的子宫不对称以及肌层回声的不均匀性，对子宫腺肌病的超声怀疑程度进行高或低评分。将超声诊断结果与子宫切除术后的组织学检查结果（n = 34）或磁共振成像结果（n = 22）进行比较。
28例患者被诊断为子宫腺肌病：15例通过组织学诊断，13例通过磁共振成像诊断。经阴道超声检查的敏感性为86%，特异性为50%，阳性预测值为86%，阴性预测值为77%。仅子宫形态测量不能预测子宫腺肌病：尽管与无子宫腺肌病的子宫相比，有子宫腺肌病的子宫纵轴、前后径和横径的平均长度更大，但未达到统计学意义。有子宫腺肌病和无子宫腺肌病的子宫不对称率分别为1.
