Application of Elastography to Diagnose Adenomyosis and Evaluate the Degree of Dysmenorrhea: a Prospective Observational Study

Overview

Journal Reprod Biol Endocrinol

Publisher Biomed Central

Specialties Endocrinology
Reproductive Medicine

Date 2023 Oct 26

PMID 37884924

Authors

Qianhui Ren

Xiangyi Dong

Ming Yuan

Xue Jiao

Hao Sun

Zangyu Pan

Xinyu Wang

Guowei Tao

Wang Guoyun

Affiliations

Soon will be listed here.

Abstract

Background: To determine whether there is a correlation between stiffness measured by strain elastography and the severity of dysmenorrhea and to determine the value of elastography in evaluating severe dysmenorrhea in patients with adenomyosis.

Methods: The correlation between tissue stiffness and dysmenorrhea was analyzed by performing elastography on premenopausal women diagnosed with adenomyosis. Expression levels of transforming growth factor-β (TGF-β), α-smooth muscle actin (α-SMA), and protein gene product 9.5 (PGP9.5) were detected by immunohistochemistry; the correlation of TGF-β and α-SMA levels with the tissue stiffness and the degree of fibrosis was further analyzed. Also, the relationship of the PGP9.5 expression level with the tissue stiffness and degree of dysmenorrhea was determined.

Results: The degree of dysmenorrhea was significantly positively correlated with lesion stiffness in patients with adenomyosis but not with the uterine or lesion volume. The cutoff for the strain ratio was > 1.36 between the adenomyosis and control groups, with an area under the curve (AUC) of 0.987. For severe dysmenorrhea, the cutoff for the strain ratio was > 1.65 in patients with adenomyosis, with an AUC of 0.849. TGF-β, α-SMA, and PGP9.5 expression levels were higher in adenomyotic lesions than in the endometrium of the adenomyosis and control groups. Both TGF-β and α-SMA levels were positively correlated with the tissue stiffness and degree of fibrosis. Additionally, the expression level of PGP9.5 showed a positive correlation with the tissue stiffness and degree of dysmenorrhea.

Conclusions: Elastography can be used to evaluate the degree of dysmenorrhea; the greater the tissue stiffness, the greater the degree of dysmenorrhea. In addition, elastography performed well in the diagnosis of adenomyosis and the evaluation of severe dysmenorrhea in patients with adenomyosis.

Citing Articles

Case Report: The first case of successful pregnancy and live birth following laparoscopic resection of adenomyosis under real-time intraoperative ultrasound elastography guidance.

Ota Y, Ota K, Takahashi T, Horikawa N, Kuroda R, Okamoto H Front Med (Lausanne). 2024; 11:1457611.

PMID: 39391043 PMC: 11464352. DOI: 10.3389/fmed.2024.1457611.

References

Chapron C, Vannuccini S, Santulli P, Abrao M, Carmona F, Fraser I . Diagnosing adenomyosis: an integrated clinical and imaging approach. Hum Reprod Update. 2020; 26(3):392-411. DOI: 10.1093/humupd/dmz049. View

Alabiso G, Alio L, Arena S, Barbasetti Di Prun A, Bergamini V, Berlanda N . Adenomyosis: What the Patient Needs. J Minim Invasive Gynecol. 2016; 23(4):476-88. DOI: 10.1016/j.jmig.2015.12.017. View

Anderson J, Fear M, Phillips J, Dawson L, Wallace H, Wood F . A preliminary investigation of the reinnervation and return of sensory function in burn patients treated with INTEGRA®. Burns. 2011; 37(7):1101-8. DOI: 10.1016/j.burns.2011.04.002. View

Liu X, Ding D, Ren Y, Guo S . Transvaginal Elastosonography as an Imaging Technique for Diagnosing Adenomyosis. Reprod Sci. 2018; 25(4):498-514. DOI: 10.1177/1933719117750752. View

Exacoustos C, Morosetti G, Conway F, Camilli S, Martire F, Lazzeri L . New Sonographic Classification of Adenomyosis: Do Type and Degree of Adenomyosis Correlate to Severity of Symptoms?. J Minim Invasive Gynecol. 2019; 27(6):1308-1315. DOI: 10.1016/j.jmig.2019.09.788. View

Akishima-Fukasawa Y, Ino Y, Nakanishi Y, Miura A, Moriya Y, Kondo T . Significance of PGP9.5 expression in cancer-associated fibroblasts for prognosis of colorectal carcinoma. Am J Clin Pathol. 2010; 134(1):71-9. DOI: 10.1309/AJCPRJP39MIDSGBH. View

Rasmussen C, den Bosch T, Exacoustos C, Manegold-Brauer G, Benacerraf B, Froyman W . Intra- and Inter-Rater Agreement Describing Myometrial Lesions Using Morphologic Uterus Sonographic Assessment: A Pilot Study. J Ultrasound Med. 2019; 38(10):2673-2683. DOI: 10.1002/jum.14971. View

Zhang Q, Duan J, Liu X, Guo S . Platelets drive smooth muscle metaplasia and fibrogenesis in endometriosis through epithelial-mesenchymal transition and fibroblast-to-myofibroblast transdifferentiation. Mol Cell Endocrinol. 2016; 428:1-16. DOI: 10.1016/j.mce.2016.03.015. View

Van den Bosch T, de Bruijn A, de Leeuw R, Dueholm M, Exacoustos C, Valentin L . Sonographic classification and reporting system for diagnosing adenomyosis. Ultrasound Obstet Gynecol. 2018; 53(5):576-582. DOI: 10.1002/uog.19096. View

10.

Wen W, Liu G, Jin K, Hu X . TGF-β1 induces PGP9.5 expression in CAFs to promote the growth of colorectal cancer cells. Oncol Rep. 2016; 37(1):115-122. DOI: 10.3892/or.2016.5238. View

11.

Shen M, Liu X, Zhang H, Guo S . Transforming growth factor β1 signaling coincides with epithelial-mesenchymal transition and fibroblast-to-myofibroblast transdifferentiation in the development of adenomyosis in mice. Hum Reprod. 2015; 31(2):355-69. DOI: 10.1093/humrep/dev314. View

12.

Guo S . Cracking the enigma of adenomyosis: an update on its pathogenesis and pathophysiology. Reproduction. 2022; 164(5):R101-R121. DOI: 10.1530/REP-22-0224. View

13.

Liu L, Li W, Leonardi M, Condous G, da Silva Costa F, Mol B . Diagnostic Accuracy of Transvaginal Ultrasound and Magnetic Resonance Imaging for Adenomyosis: Systematic Review and Meta-Analysis and Review of Sonographic Diagnostic Criteria. J Ultrasound Med. 2021; 40(11):2289-2306. DOI: 10.1002/jum.15635. View

14.

Lazzeri L, Morosetti G, Centini G, Monti G, Zupi E, Piccione E . A sonographic classification of adenomyosis: interobserver reproducibility in the evaluation of type and degree of the myometrial involvement. Fertil Steril. 2018; 110(6):1154-1161.e3. DOI: 10.1016/j.fertnstert.2018.06.031. View

15.

Berkley K, Dmitrieva N, Curtis K, Papka R . Innervation of ectopic endometrium in a rat model of endometriosis. Proc Natl Acad Sci U S A. 2004; 101(30):11094-8. PMC: 491992. DOI: 10.1073/pnas.0403663101. View

16.

Cunningham R, Horrow M, Smith R, Springer J . Adenomyosis: A Sonographic Diagnosis. Radiographics. 2018; 38(5):1576-1589. DOI: 10.1148/rg.2018180080. View

17.

Tokushige N, Markham R, Russell P, Fraser I . High density of small nerve fibres in the functional layer of the endometrium in women with endometriosis. Hum Reprod. 2005; 21(3):782-7. DOI: 10.1093/humrep/dei368. View

18.

Van den Bosch T, Dueholm M, Leone F, Valentin L, Rasmussen C, Votino A . Terms, definitions and measurements to describe sonographic features of myometrium and uterine masses: a consensus opinion from the Morphological Uterus Sonographic Assessment (MUSA) group. Ultrasound Obstet Gynecol. 2015; 46(3):284-98. DOI: 10.1002/uog.14806. View

19.

Yang B, Gu N, Shi S, Zhang C, Chen L, Ouyang J . Immunoreactivity of Plasminogen Activator Inhibitor 1 and Its Correlation with Dysmenorrhea and Lesional Fibrosis in Adenomyosis. Reprod Sci. 2021; 28(8):2378-2386. PMC: 8289782. DOI: 10.1007/s43032-021-00513-6. View

20.

Xholli A, Londero A, Cavalli E, Scovazzi U, Ferraro M, Vacca I . The Benefit of Transvaginal Elastography in Detecting Deep Endometriosis: A Feasibility Study. Ultraschall Med. 2023; 45(1):69-76. DOI: 10.1055/a-2028-8214. View