Sonography of adenomyosis.

Sonography of Adenomyosis denomyosis was first described by Rokitansky in 1860 as " cystosarcoma adenoides uterinum " and was later defined by Von Recklinghausen in 1896. It is a common condition that predominantly affects women in the late reproductive years. Adenomyosis has been noted to occur in about 30% of the general female population and in up to 70% of hysterectomy specimens depending on the definition of the entity. 1 The diagnosis can be made with sonography or magnetic resonance imaging (MRI), but this article will show that sonography should be the imaging modality of choice for adenomyosis. Definition Adenomyosis is defined by the presence of ectopic endometrial glands and stroma within the myometrium. The presence of ectopic endometrial glands and stroma induces a hypertrophic and hyper-plastic reaction in the surrounding myometrial tissue. Most patients with adenomyosis are asymptomatic. Symptoms related to adenomyosis include dysmenorrhea, dyspareunia, chronic pelvic pain, and menstrual menometrorrhagia. Adeno-myosis presents most commonly as a diffuse disease involving the entire myometrium (Figure 1). It can also present in a focal area of the uterus, known as adenomyoma (Figure 2). Adenomyosis can also be associated with other conditions, such as leiomyomata, endometrial polyps, and endo metriosis. 2 The establishment of the clinical diagnosis of adenomyosis is difficult because of its vague presenting symptoms. A homogeneously enlarged (globular) uterus on pelvic examination is suggestive of the diagnosis. Diagnosis The diagnosis of adenomyosis is made on a pathologic specimen, obtained after hysterectomy. The pathologic diagnosis is dependent on the visualization of endometrial glands and stroma in more than 1 low-powered field (2.5 mm) from the endometrial basalis layer. 3 The diagnosis can also be made by imaging with the use of sonog-raphy or MRI. A recent meta-analysis on the accuracy of sonogra-phy in the diagnosis of adenomyosis showed that it had sensitivity of 82. The Sound Judgment Series consists of invited articles highlighting the clinical value of using ultrasound first in specific clinical diagnoses where ultrasound has shown comparative or superior value. The series is meant to serve as an educational tool for medical and sonography students and clinical practitioners and may help integrate ultrasound into clinical practice.