Feasibility study of the application of Magnetic Resonance Elastography (MRE) to diagnose adenomyosis

Abstract

Structured AbstractIntroductionAdenomyosis is an under-recognised condition in which definitive diagnosis is only possible via histology after hysterectomy, an unacceptable option for those wishing to preserve fertility. Recent cellular/molecular studies indicate adenomyotic lesions may be fibrotic leading to increased uterine tissue stiffness. 3D Magnetic Resonance Elastography (MRE) is a novel imaging technique that allows in vivo measurement of tissue stiffness (via elastograms). 3D MRE has not been reported to study adenomyosis. The feasibility study aimed to utilise a novel 3D MRE protocol to measure global uterine stiffness and to investigate its potential application for non-invasive in vivo diagnosis of adenomyosis.Materials and Methods3D MRE protocol was conducted on one healthy volunteer (control) and four patients with suspected adenomyosis and heavy menstrual bleeding (HMB), diagnosed via transvaginal ultrasound and clinical history (REC:20/SS/0123 and 19/SS/0102). Two patients underwent hysterectomy, and representative uterine tissue samples were assessed for (i) histological presence of adenomyosis via H&E staining; (ii) cellular/molecular measures of tissue stiffness (collagen [picrosirius red], α-smooth muscle actin, e-cadherin); (iii) relationship between in vivo assessment of the uterus via MRI images and 3D MRE findings with in vitro uterine tissue histology from the same individuals.Results3D MRE was successfully used to acquire elastograms for four patients with adenomyosis (diffuse n=3, focal n=1) and one healthy volunteer. Calculated global uterine stiffness was higher in women with adenomyosis (2.93kPa; range 2.34 – 3.39kPa) compared to a healthy volunteer (2.04kPa). Areas of stiffness on 3D elastograms reflected adenomyotic changes visualised via conventional MRI, with the added benefit of also correlating with histology/immunohistochemical assessment for markers of tissue stiffness.DiscussionA novel 3D MRE protocol has been applied to obtain the global uterine stiffness in four women with HMB and suspected adenomyosis, and one healthy volunteer. 3D MRE has the potential to provide superior non-invasive tissue characterisation in vivo when compared to conventional MRI in the assessment of adenomyosis due to the correlation of imaging and tissue findings. Further studies are now needed to confirm the above exploratory findings, prior to performing a potential clinical trial.