الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Endometrial glands and stroma placed randomly deep inside the myometrium are referred to as adenomyosis. These misplaced glands induce spiral vessel angiogenesis, SM hyperplasia, and hypertrophy, resulting in junctional zone thickening and, in severe cases, generalised uterine enlargement.
Multiple risk factors are suggested for adenomyosis including patients with increased parity, high oestrogen exposure, such as those who have early menarche, relatively short menstrual cycles, and an increased BMI. Increased oestrogen levels or endometrial invasion of the myometrium with trophoblastic implantation have been proposed as two possible explanations of the risk associated with multiparity.
As the frequency of occurrence of adenomyosis appears to be rising in women who have previously had D&C or a caesarean section, disruption of the endometrial-myometrial interface during surgery is another proposed route of invasion. However, the physio-pathological pathways including abnormalities in sex steroid hormones, inflammation, fibrosis, and neuroangiogenesis remain unknown.
Adenomyosis has a variety of clinical manifestations, the most frequent of which are heavy menstruation and dysmenorrhoea; however, individuals might be asymptomatic as well.
Numerous studies endorse the concept that adenomyosis is caused by endometrial invasion into the myometrium, resulting in junctional zone changes. Imaging techniques, such as transvaginal ultrasonography and magnetic resonance imaging, frequently reveal these alterations.
The purpose of this study is to evaluate the diagnostic accuracy of TVUS in the detection of adenomyosis, in comparison to MRI as the gold standard.
This study included 25 patients referred to Department of Radiodiagnosis at Alexandria Main University Hospital for MRI and transvaginal ultrasound.
A thorough history was taken from the patients. All patients underwent MRI and TVUS.
In our study, the age of the studied cases ranged between 21 and 55 years with mean age 38 years. Patients presented with different symptoms where multiple symptoms encountered in each case, the most common symptoms of adenomyosis were chronic pelvic pain (19/25) (76%) and vaginal bleeding (15/25) (60%).
Our study showed that even though multiparity could be a risk factor for adenomyosis as mean parity of the patients was (3.04 ± 2.01) it could also affect younger nulliparous women as 4 (16%) of the cases hadn’t been pregnant before with mean age of the patients (38.28 ± 9.17) and (40%) of the cases being ≤35 years old.
In our study patients underwent both normal, C.S. deliveries or both so for facilitating the comparison between the types of delivery we decided to compare the total number of deliveries of both normal and CS regardless of the patients’ sample size and we ended up with 80 deliveries distributed as 36 (45%) normal deliveries 40 (50%) Caesarean sections and 4 (5 %) didn’t undergo any type of delivery before (nulliparous).
Our study showed that adenomyosis could be associated with other multiple gynecological diseases where 15/25 (65.2%) of the cases had associated deep pelvic endometriosis followed by 9/25 (39.1%) of the cases had associated uterine fibroids.