Fibroids or adenomyosis
A myomatous node and a focus of adenomyosis are similar on a regular ultrasound: both look like an area of altered structure in the wall of the uterus. It is important to distinguish between them, because the treatment is fundamentally different - from hormonal therapy to embolization of the uterine arteries or removal of the node.
Myoma is a dense node, clearly demarcated from the myometrium, with its own pseudocapsule, and on the elastogram it gives a sharp border of rigidity. Adenomyosis grows into the muscle layer diffusely, without a capsule, so the transition of stiffness from the lesion to the surrounding tissue is gradual. This sign is one of the most useful results of elastography in gynecology.
For ovarian formations, the method complements the assessment using the O-RADS system: simple cysts are soft, while solid components with high rigidity require more careful attention and consultation with a gynecological oncologist. The study is performed with a transvaginal sensor, optimally in the first phase of the cycle.
What does elastography show?
Elastography measures the stiffness (elasticity) of tissue - a parameter that a doctor could previously assess only with his hands during palpation. Healthy tissue is soft and easily deformed, while scar, fibrous and tumor tissue is dense and rigid. The method translates this feeling into objective numbers that can be compared between studies.
The main practical value is in the differential diagnosis of focal formations. Benign nodes usually retain the elasticity of the surrounding tissue, while malignant ones are noticeably stiffer. This helps decide which nodes need to be monitored and which ones require a biopsy.
Compression and shear wave techniques
Compression elastography is based on light pressure with a sensor: the device compares tissue deformation and builds a color map. The method is qualitative - it shows what is harder and what is softer, but does not give absolute values.
Shear wave elastography (shear wave, which also includes liver fibroscan) uses the acoustic pulse of the device itself and measures the speed of propagation of the shear wave. The result is quantitative - in kilopascals, which allows you to track the dynamics during treatment.
Limitations of the method
The result is influenced by severe obesity, edema and active inflammation in the area of interest, as well as the depth of the formation: the deeper it is, the less reliable the measurements. Large calcifications and cysts produce artifacts.
Elastography is not an independent diagnosis, but one of the parameters. The final conclusion about the nature of the formation is given by a morphological study, that is, a biopsy.