In Search of an Imaging Classification of Adenomyosis: A Role for Elastography?
Abstract
:1. The Tower of Babel
2. Early Attempts to Classify Adenomyosis
3. The Current State of Diagnostic Tools
4. Imaging-Based Classification of Adenomyosis
5. The Physical Limits of TVUS and MRI
6. The Case for Incorporation of Elastography to Move Forward
7. Emerging Problems with the Utilization of Elastography
8. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Author(s) and Year of Publication | Imaging Platform | Proposed Classification | Rationale | Remarks |
---|---|---|---|---|
Kishi et al. (2012) [19] | MRI | Four subtypes: I: intrinsic; II: extrinsic; III: intramural; IV: indeterminate | Based on Sampson’s observation as well as clinical observations | Subtypes I and II appear to have different pathogenesis, symptomology, and severity |
Van den Bosch et al. (2015) [36] Revised in Harmsen et al. (2022) [21] (The MUSA standard) | TVUS | Direct features: Cysts, hyperechogenic islands, echogenic subendometrial lines and buds. Indirect features: Asymmetrical thickening, globular uterus, irregular JZ, fan-shaped shadowing, translesional vascularity, interrupted JZ. | Based on expert consensus through several rounds of modified Delphi procedure | A welcome step towards the establishment of standardized terminology, with the goal to build a uniformly accepted or validated system to diagnose or classify the severity of adenomyosis based on imaging findings. |
Bazot and Darai (2018) [14] | MRI | Three subtypes: -Internal -External -Adenomyoma | Based on Sampson’s observation as well as clinical observations | Different subtypes appear to have different pathogenesis, symptomatology, and severity |
Gordts et al. (2018) [5] | MRI/TVUS/hysteroscopy | Important parameters to be included in a classification system: Affected area (inner or outer myometrium), localization (anterior, posterior, or fundus), pattern (diffuse or focal), type (muscular or cystic), volume or size (expressed as <1/3, <2/3, >2/3 or in cm) | These parameters are potentially related to symptomatology and/or severity | Included parameters are important for accurate diagnosis and, through grading, may be associated with disease severity. |
Van den Bosch et al. (2019) [37] | TVUS | Location (anterior, posterior, left or right lateral side, or fundus), differentiation (focal, diffuse, or mixed type), cysticity (cystic or non-cystic), uterine layer involvement ( I: involving inner/sub-endometrial myometrium; II: involvement of middle myometrium; III: involvement of outer/sub-serosal myometrium), extent (<1/4, ≥1/4 but ≤1/2, >1/2 myometrium), and size. | Based on consensus among sonographers, and consistent with the previous MUSA consensus. | A welcome first step towards an internationally accepted classification and reporting system |
Kobayashi and Matsubara (2020) [20] | MRI | Five main categories: (1) affected area (internal vs. external), (2) pattern (diffuse, focal); (3) size (<1/3, <2/3, or >2/3 of uterine wall); and (4) localization (anterior, posterior, left lateral, right lateral, and fundus); (5) concomitant pathologies (none, PE, OE, DE, UF, others) | Adopted from previous proposals of classification | Combined all important features of adenomyosis that may be useful for proper classification |
Exacoustos et al. (2020) [25] | TVUS | Type (focal, diffuse, or adenomyomas), Extension of the lesion in the myometrium | Empirical observations | These variables seem to correlate with the severity of symptoms and infertility |
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Guo, S.-W.; Benagiano, G.; Bazot, M. In Search of an Imaging Classification of Adenomyosis: A Role for Elastography? J. Clin. Med. 2023, 12, 287. https://doi.org/10.3390/jcm12010287
Guo S-W, Benagiano G, Bazot M. In Search of an Imaging Classification of Adenomyosis: A Role for Elastography? Journal of Clinical Medicine. 2023; 12(1):287. https://doi.org/10.3390/jcm12010287
Chicago/Turabian StyleGuo, Sun-Wei, Giuseppe Benagiano, and Marc Bazot. 2023. "In Search of an Imaging Classification of Adenomyosis: A Role for Elastography?" Journal of Clinical Medicine 12, no. 1: 287. https://doi.org/10.3390/jcm12010287