The Diagnostic Utility of Uterine Artery Doppler in Distinguishing Adenomyosis from Uterine Fibroids
Keywords:
Adenomyosis; Uterine Fibroids; Doppler Ultrasonography; Uterine Artery; Resistive Index; Pulsatility IndexAbstract
Uterine fibroids (leiomyomas) and adenomyosis are among the most common benign uterine disorders affecting women of reproductive age. Their overlapping clinical manifestations frequently make differentiation difficult, despite the fact that management strategies differ considerably. Although conventional ultrasound is the first-line imaging modality, Doppler ultrasonography may improve diagnostic accuracy by evaluating the vascular characteristics of these lesions. This study was conducted to evaluate the diagnostic performance of uterine artery Doppler ultrasonography in differentiating adenomyosis from uterine fibroids using Doppler hemodynamic indices. This prospective analytical study included 50 women with clinically suspected uterine fibroids or adenomyosis. All participants underwent grayscale ultrasound examination followed by uterine artery Doppler assessment. Doppler parameters, including the Resistive Index (RI), Pulsatility Index (PI), and Peak Systolic Velocity (PSV), were analyzed. Magnetic resonance imaging (MRI) was used as the reference standard when indicated. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal diagnostic cut-off values, and diagnostic performance was assessed using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). The mean age of the study population was 46.74 ± 4.45 years. Uterine fibroids demonstrated a hypervascular, low-resistance flow pattern, whereas adenomyosis exhibited a high-resistance vascular profile. Optimal Doppler cut-off values for fibroids were RI 0.83, PI 2.32, and PSV 39.74 cm/s, while adenomyosis was characterized by RI 0.92, PI 3.25, and PSV 19.62 cm/s. The Pulsatility Index showed the highest specificity (93.9%) for diagnosing adenomyosis, while Peak Systolic Velocity served as a useful complementary parameter. Overall, uterine artery Doppler indices demonstrated good diagnostic performance in distinguishing the two conditions. Uterine artery Doppler ultrasonography is a reliable, non-invasive, and readily available imaging technique for differentiating adenomyosis from uterine fibroids. Assessment of Doppler vascular indices, particularly RI and PI, enhances diagnostic confidence and may facilitate appropriate clinical management while reducing the need for more expensive imaging modalities.
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