Comparative Study Of MRI And US In The Diagnosis Of Adenomysis

ObjectiveThe aim of this study was to compare the diagnostic performance of Magnetic Resonance Imaging(MRI)with Ultrasound(US)examination in the diagnosis of uterine adenomyosis, to detect further clinical practical value and provide reliable objective evidence for clinical treatment.Materials and MethodsFrom August 2009 to February 2011,102 women who were suspected uterine adenomyosis or leiomyoma in initial clinical diagnosis were enrolled. All patients respectively were subjected to MRI and US. Moreover, they underwent diffusion-weighted imaging (DWI) in addition to routine MR imaging.These imagings were used 3D-MIP and Functiontool on the DWI image post-processing, measured ADC value of lesion tissues and compared statistical differences. 28 patients were underwent dynamic enhanced scans, and these imagings were analysed the enhanced feature and compared whether its could be helpful in the differentiation of uterine adenomyosis and leiomyoma. Histopathologic examination was conducted as the golden standard.Results1.There were 48 women with uterine adenomyosis,53 women with uterine leiomyoma and one patient with hemangioma of uterus by histopathologic confirmation.MRI found 46 women with adenomyosis and 56 women with uterine leiomyoma.Using histological confirmation as the gold standard,The diagnosis rate of adenomyosis for MRI was 91.6%, Misdiagnosis rate was 3.70%, missed diagnosis rate was 8.33%. The sensitivity, specificity, accuracy and positive predictive value(PPV), negative predictive value(NPV), positive likelihood ratio(LR+) and negative likelihood ratio(LR-) for diagnosis of MRI adenomyosis were 91.67%, 96.30 %,94.12%, 95.65%, 92.86%, 24.78, 0.09, You den index = 0.8797. US found 44 women with adenomyosis and 58 women with uterine myoma. The diagnosis rate of adenomyosis for US was 83.33%, Misdiagnosis rate was 12.70%, missed diagnosis rate was 21.28%. The sensitivity, specificity, accuracy and PPV, NPV, LR+ and LR- for diagnosis of US adenomyosis were 78.72%, 87.27%, 83.33%, 84.09%, 82.76%, 6.18, 0.24, You den index = 0.6599. The comparison of sensitivity, specificity and accuracy of two diagnosis had significant differences on statistics (P = 0.000,0.022,0.015<0.05), indicating that MRI examination was very superior to US in the diagnosis of adenomyosis.2.The enhanced features of 28 patients (including 18 lesions of adenomyosis and 25 lesions of myoma)found 4 lesions with adenomyosis and 20 lesions with leiomyoma with ring enhancement patterns .It had notable discrepancy on statistics (P=0.000 <0.05). In addition,Strengthen the signal characteristics in both adenomyosis and leiomyoma of uterus was statistically significant (P=0.015<0.05). It demonstrated that enhanced scans should be helpful in differential diagnosis of uterine adenomyosis and leiomyoma.3. b = 700s/mm²,the ADC value of adenomyosis 1.59±0.20×10^-3mm²/s, myoma of uterus ADC value 1.70±0.33×10^-3mm²/s. There are notable discrepancy on statistics (P = 0.004 <0.05).Conclusion1.The sensitivity, specificity, accuracy for MRI are more superior than for US in the diagnosis of adenomyosis, and MRI examination has outstanding clinical practical value.2.MRI can show clearly structure of the uterus, qualitative and locate in diagnosis, and provide an reliable basis for the treatment. Moreover,MRI dynamic enhancement scan is a more useful examination in the differential diagnosis of adenomyosis and leiomyoma of uterus.3.There are significant discrepancy on statistics between ADC values of adenomyosis and uterine myoma,suggest that their pathological changes and spatial structure should be different. Therefore, DWI and ADC value can be applied for the further differentiation of uterine adenomyosis and leiomyoma in addition to routine MR imaging.