Abstract：
OBJECTIVE: What is the prevalence of adenomyosis at ultrasonography among adolescents and young women reporting dysmenorrhoea and/or heavy menstrual bleeding (HMB)?
METHODS: This observational cohort study involved adolescents and young women referred for dysmenorrhoea and/or HMB to the Adolescent Medicine Unit at Careggi University Hospital, Italy. Patients with endometriosis and bleeding disorders were excluded. Transvaginal ultrasonography or transrectal sonography using a transvaginal probe was performed. The myometrium was described according to the Morphological Uterus Sonographic Assessment criteria. Details of baseline characteristics, clinical data and symptoms were collected. The presence of sonographic features of adenomyosis and the association between imaging findings and clinical symptoms were evaluated.
RESULTS: The cohort included 95 patients aged between 13 and 25 years, referred for dysmenorrhoea (88.4%), HMB (23.2%) or both (13.7%). According to the MUSA criteria the sonographic diagnosis of adenomyosis was made in 27.4% of patients, with the diffuse type the most prevalent. Uterine wall asymmetry, hyperechoic intramyometrial islands, translesional vascularity and an interrupted junctional zone were the most common features. Patients with imaging findings of adenomyosis had significantly higher rates of HMB than those with a normal myometrial appearance (38.5% versus 17.4%, P = 0.030). In addition, the coexistence of dysmenorrhoea and HMB was significantly associated with adenomyosis (odds ratio 5.68, 95% confidence interval 1.65-19.5).
CONCLUSIONS: Adenomyosis may be diagnosed among teenagers and young women referred with dysmenorrhoea and/or HMB. The clinical presentation is relevant for the diagnosis, with HMB alone and HMB plus dysmenorrhoea significantly associated with the sonographic identification of adenomyosis.
METHODS: This observational cohort study involved adolescents and young women referred for dysmenorrhoea and/or HMB to the Adolescent Medicine Unit at Careggi University Hospital, Italy. Patients with endometriosis and bleeding disorders were excluded. Transvaginal ultrasonography or transrectal sonography using a transvaginal probe was performed. The myometrium was described according to the Morphological Uterus Sonographic Assessment criteria. Details of baseline characteristics, clinical data and symptoms were collected. The presence of sonographic features of adenomyosis and the association between imaging findings and clinical symptoms were evaluated.
RESULTS: The cohort included 95 patients aged between 13 and 25 years, referred for dysmenorrhoea (88.4%), HMB (23.2%) or both (13.7%). According to the MUSA criteria the sonographic diagnosis of adenomyosis was made in 27.4% of patients, with the diffuse type the most prevalent. Uterine wall asymmetry, hyperechoic intramyometrial islands, translesional vascularity and an interrupted junctional zone were the most common features. Patients with imaging findings of adenomyosis had significantly higher rates of HMB than those with a normal myometrial appearance (38.5% versus 17.4%, P = 0.030). In addition, the coexistence of dysmenorrhoea and HMB was significantly associated with adenomyosis (odds ratio 5.68, 95% confidence interval 1.65-19.5).
CONCLUSIONS: Adenomyosis may be diagnosed among teenagers and young women referred with dysmenorrhoea and/or HMB. The clinical presentation is relevant for the diagnosis, with HMB alone and HMB plus dysmenorrhoea significantly associated with the sonographic identification of adenomyosis.
摘要：
目的：报告痛经和/或月经大出血（HMB）的青少年和年轻女性超声检查子宫腺肌病的患病率是多少？
方法：这项观察性队列研究包括因痛经和/或HMB转诊到Careggi大学医院青少年医学部门的青少年和年轻女性，意大利。子宫内膜异位症和出血性疾病患者被排除在外。使用经阴道探头进行经阴道超声检查或经直肠超声检查。根据形态学子宫超声检查评估标准描述子宫肌层。基线特征的详细信息，收集临床资料和症状。评估了子宫腺肌病的超声特征以及影像学表现与临床症状之间的关联。
结果：该队列包括95名年龄在13至25岁之间的患者，因痛经(88.4%)，HMB(23.2%)或两者(13.7%)。根据MUSA标准，27.4%的患者超声诊断为子宫腺肌病，扩散型最普遍。子宫壁不对称，高回声肌层内岛，血管横断和交界区中断是最常见的特征。影像学表现为子宫腺肌病的患者HMB的发生率明显高于肌层外观正常的患者（38.5％对17.4％，P=0.030)。此外,痛经和HMB共存与子宫腺肌病显著相关(比值比5.68,95%置信区间1.65~19.5).
结论：子宫腺肌病可在青少年和年轻女性中诊断为痛经和/或HMB。临床表现与诊断有关，单独使用HMB和HMB加痛经与子宫腺肌病的超声识别显着相关。
方法：这项观察性队列研究包括因痛经和/或HMB转诊到Careggi大学医院青少年医学部门的青少年和年轻女性，意大利。子宫内膜异位症和出血性疾病患者被排除在外。使用经阴道探头进行经阴道超声检查或经直肠超声检查。根据形态学子宫超声检查评估标准描述子宫肌层。基线特征的详细信息，收集临床资料和症状。评估了子宫腺肌病的超声特征以及影像学表现与临床症状之间的关联。
结果：该队列包括95名年龄在13至25岁之间的患者，因痛经(88.4%)，HMB(23.2%)或两者(13.7%)。根据MUSA标准，27.4%的患者超声诊断为子宫腺肌病，扩散型最普遍。子宫壁不对称，高回声肌层内岛，血管横断和交界区中断是最常见的特征。影像学表现为子宫腺肌病的患者HMB的发生率明显高于肌层外观正常的患者（38.5％对17.4％，P=0.030)。此外,痛经和HMB共存与子宫腺肌病显著相关(比值比5.68,95%置信区间1.65~19.5).
结论：子宫腺肌病可在青少年和年轻女性中诊断为痛经和/或HMB。临床表现与诊断有关，单独使用HMB和HMB加痛经与子宫腺肌病的超声识别显着相关。
