The diagnostic significance of Color Doppler ultrasound for adenomyosis involves understanding the injury or procedural complications, such as excessive dilation and curettage [2].
3.2 The relationship between sonographic and pathological findings can be roughly classified into different controls:
① Myometrial heterogeneous echo: Pathological specimens show that the myometrium is not obviously thickened, but the wall has scattered coffee-like cysts measuring 2-6mm. Under the microscope, ectopic glands and more non-active cysts around the interstitial structure and neighboring smooth muscle exhibit varying degrees of hyperplasia. These pathological changes correspond to sonographic changes.
(2) Uterine myometrium high echo-ray group: Such lesions generally show clearer boundaries of masses or nodules, with a swirling structure in the muscle wall. Part of it shows small blood-stale plots and coffee-like cavities under the microscope. The distribution of muscularis islands around the glands exhibits a whirlpool-like arrangement with more interstitial tissue. These pathological features form high echogenic masses in the sonogram.
③ On the sonogram, the myometrium shows hypoechoic or anechoic mass types. Gross specimens of the muscularis show coffee-like cavities with large diameters of 4-10mm, and some even reach 2-3cm. Under the microscope, smooth muscle hyperplasia is significantly evident compared to the middle of the cystic dilatation of glands. There are fewer interstitial low or anechoic fluid-containing cysts, showing a corresponding relationship with audio-visual ISSN:1006-6233 (2005) 05-0416-03. The above pathological changes are associated with the sonogram's related performance.
3.3 In this group of patients, the diagnosis accuracy was 69%, consistent with other domestic reports. Adenomyosis sonograms can easily be confused with multiple small uterine fibroids and other causes of enlarged uterus diseases due to complex and volatile changes without characteristic features, leading to misdiagnosis. The causes of misdiagnosis in this group of patients are summarized as follows:
① Patients with obesity and a history of abdominal surgery, where abdominal scars affect the quality of ultrasound images.
(2) Uterine hypertrophy of muscle fibers, this type of uterine echogenicity, where the uterine muscle has a heterogeneous echo texture similar to adenomyosis imaging.
③ A history of dysfunctional uterine bleeding and adenomyosis patients with similar menstrual disorders, with increased echogenicity of the uterine muscle in the light group.
(4) Cross-sectional intrauterine expansion of the spiral artery and vein may be mistaken for adenomyosis cystic cavities. Image approximation makes confirmation difficult; therefore, a detailed inquiry into the patient's history of dysmenorrhea should be noted and combined with clinical and gynecological examinations.
In addition, the technical level of the ultrasound operator should be improved to obtain high-quality images, and conditions can allow for vaginal ultrasound. This group of patients shows sonographic and pathological changes closely related to the increasing prevalence of adenomyosis in recent years among women of childbearing age with dysmenorrhea history or menstrual abnormalities. Attention should be paid to whether adenomyosis exists, not just relying on the uterine myometrium's brightness or dark areas. The heterogeneous echo texture of the uterine muscle, enlarged uterus (especially spherical increase), should be combined with clinical history to determine adenomyosis. If a chocolate cyst exists, the reliability of the diagnosis will greatly increase. The application of Color Doppler will help improve the diagnosis rate.