Uterine adenomyosis. A difficult sonographic diagnosis.

In an effort to distinguish the appearance of generalized uterine adenomyosis from leiomyoma, a retrospective study was performed on 80 patients who had preoperative uterine sonography. A diagnosis of adenomyosis (eight patients) was suggested if the uterus was diffusely enlarged, but the myometrial texture, contour, and central cavity echoes were each normal. Leiomyoma, or other focal uterine pathology (72 patients) was characterized by focal or globular uterine enlargement with abnormal echo texture and contour, as well as nonvisualization or displacement of the central cavity echo complex. Using these criteria, ultrasound was able to suggest adenomyosis with a sensitivity of 63%, a specificity of 97%, and a positive predictive value of 71%. Focal pathology was diagnosed with a sensitivity of 97%, a specificity of 63%, and a positive predictive value of 96%. Although irregular myometrial sonolucent zones have previously been reported as characteristic for adenomyosis, this study did not confirm this finding.