Transvaginale Ultraschalldiagnostik der Adenomyose

Adenomyosis is a frequent benign uterine condition, which can cause symptoms, such as dysmenorrhea, dyspareunia, lower abdominal pain and bleeding disorders in most affected women. Adenomyosis is related to a negative impact on fertility with higher abortion rates and lower success rates in assisted reproduction and it can cause obstetrical complications, such as premature rupture of membranes, premature birth, placentation failure, uterine rupture and fetal growth retardation. The exact incidence of adenomyosis remains uncertain as the available data are based on cohort studies in which the diagnosis was confirmed by hysterectomy; however, adenomyosis can occur from adolescence up to the postmenopausal epoch. Due to the lack of reliable methods of obtaining histological samples without damaging organs, the diagnosis is made based on imaging procedures. In the hands of experienced investigators magnetic resonance imaging (MRI) and transvaginal ultrasound are comparable with respect to the diagnostic reliability. Due to its relatively low cost and accessibility, ultrasound diagnostics and in particular two-dimensional transvaginal sonography represent the first-line imaging approach. The sonographically visible alterations to the uterus described in the literature are divided into direct and indirect signs. The reliability of the interpretation of the results depends on the individual experience of the investigator and the technical quality of the ultrasound scanner.