Observational studyJournal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine2026
A Novel Semi-Quantified Method for Grading Sonographic Severity of Adenomyosis and its Relation With Clinical Symptoms: An Observational Study.
Observational study in Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo correlate the sonographic severity of adenomyosis, assessed with real-time ultrasound and a novel semi-quantified method (XI-VOCAL counting and categories) with adenomyosis-associated symptoms.
methodsThis observational study was conducted in a tertiary referral outpatient clinic. We consecutively included 115 participants with ≥1 direct ultrasonographic adenomyosis feature; those with dominant myoma, malignancy, pelvic infection, pregnancy, breastfeeding, inadequate imaging, postmenopause, or hormonal medication use were excluded. A routine clinical protocol was followed for anamnestic and ultrasound data. Menstrual bleeding was assessed subjectively (three-point scale) and with a pictorial blood loss analysis chart (PBAC). Dysmenorrhea, dyspareunia, and chronic pelvic pain were evaluated using a numeric rating scale (NRS). A retrospective questionnaire was sent for missing items. Real-time severity was scored by experienced gynecologists. XI-VOCAL-based severity was assessed independently and blinded to clinical data, providing two severity scores: XI-VOCAL counting and XI-VOCAL categories. Correlations with symptoms were analyzed using Jonckheere-Terpstra, linear and logistic regression.
resultsThe real-time severity (severe vs mild) showed a strong correlation with adjusted PBAC (β 590.01, 95% CI 207.16-972.86, P < .01) and subjective blood loss assessment (OR 5.48, 95% CI 1.14-26.28, P < .05). Additionally, a strong correlation was found between XI-VOCAL counting and XI-VOCAL categories with adjusted PBAC score (XI-VOCAL counting: β 53.15, 95% CI 12.06-94.24, P < .05; XI-VOCAL categories (severe vs mild): β 627.36, 95% CI 165.92-1088.81, P < .05). No correlations were found with adjusted dysmenorrhea, chronic abdominal/pelvic pain, or dyspareunia.
conclusionBoth real-time severity and XI-VOCAL-assessed severity correlate with adjusted PBAC scores and subjective blood assessment. XI-VOCAL appears more standardized, while real-time assessment may be influenced by symptom severity. Larger studies correcting for pain-related confounders are needed.
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