Evaluation of the Relationship Between Adenomyosis and Cervical Elastography Parameters

<b>Objectives:</b> We aim to investigate cervical biomechanical alterations associated with adenomyosis using shear-wave elastography (SWE), and to explore the discriminative potential of cervical SWE parameters. <b>Methods:</b> In this prospective study, 84 patients with adenomyosis, diagnosed both clinically and by ultrasonography according to the MUSA parameters, and 65 healthy women underwent elastography to the cervix with SWE. Six areas of the cervix were evaluated: anterior and posterior internal os, middle part of the cervix, and external os. <b>Results:</b> The adenomyosis group showed a significantly higher cervical length (27.3 ± 5.5 mm vs. 23.8 ± 4.6 mm), as well as greater anterior (11.3 ± 2.4 mm vs. 9.9 ± 1.3 mm) and posterior (11.3 ± 2.2 mm vs. 10.5 ± 1.8 mm) cervical measurements compared with the controls (<i>p</i> < 0.001). SWE showed higher stiffness measurements for the anterior and posterior internal os (22.3 ± 5.4 kPa and 22.2 ± 4.9 kPa) compared with the controls (15.5 ± 5.8 kPa and 15.7 ± 5.6 kPa, respectively; <i>p</i> < 0.001). Receiver operating characteristic analysis demonstrated high discrimination for these measurements, with area under curve values of 0.804 for the anterior internal os and 0.808 of posterior internal os. Optimal cut-offs were 17.5 kPa (sensitivity 82%, specificity 70%) and 18.5 kPa (sensitivity 81%, specificity 74%). <b>Conclusions:</b> Cervical elastography may serve as a non-invasive adjunctive tool for exploring disease-related biomechanical changes and for supporting imaging-based assessment of adenomyosis.