Differential diagnosis of uterine myoma and adenomyosis using conventional ultrasound and transvaginal color doppler technique

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  • KAWAMATA CHIZUKO
    Department of Gynecology and Obstetrics, Juntendo University, School of Medicine
  • MACHIDA MASAHIRO
    Department of Gynecology and Obstetrics, Juntendo University, School of Medicine
  • NAKAJO MAMIKO
    Department of Gynecology and Obstetrics, Juntendo University, School of Medicine
  • TAKEUCHI HISAYA
    Department of Gynecology and Obstetrics, Juntendo University, School of Medicine
  • TAKADA MICHIO
    Department of Gynecology and Obstetrics, Juntendo University, School of Medicine

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  • 超音波断層法・経腟カラードップラー法による子宮筋腫と子宮腺筋症の鑑別診断に関する研究

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Even with present day advances in ultrasono-tomography, differential diagnosis of uterine adenomyosis is difficult. We conducted this study to improve the results of differential diagnosis. During the 2 year period since 1987, in regard to a total of 116 cases including 81 cases of uterine myoma and 35 cases of uterine adenomyosis whose uterus was extirpated and underwent a definite histopathological diagnosis, we retrospectively studied the diagnostic accuracy rate of preoperative ultrasound diagnosis. Although the diagnostic sensitivity was favorable for uterine myoma, it was low for uterine adenomyosis, showing a sensitivity of 34.1%, specificity of 98.8%, and accuracy of 78.4%, so that the difficulty of correctly diagnosing uterine adenomyosis became increasingly evident. Looking at the images of these same cases stored on optical disks, we studied in detail the readings of the nodular images important in differential diagnosis, and found that we were able to pick up these characteristic findings, but the establishment of differential diagnostic criteria was difficult. Therefore, from September through December, 1990 in cases whose histopathological diagnosis was confirmed following extirpation of the uterus we used an extremely new ultrasound diagnostic technique, namely, the transvaginal color doppler method. We detected the blood flow rate wave form of the radial arteries as the afferent blood vessels of the nodules, and calculated their resistence index (RI). The RI of 28 uterine myoma cases averaged 0.54±0.11 and it averaged 0.78±0.07 for 8 cases of uterine adenomyosis, so that at a risk rate of 0.1 % a significant difference was observed, thus suggesting that this index will be of assistance in the differential diagnosis.

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