Association Between 3D Transvaginal Ultrasound-Based XI VOCAL Counting Severity and Tissue MMP-9 Levels in Patients with Adenomyosis.
- 1Department of Obstetrics and Gynecology, Hasan Sadikin General Teaching Hospital, Faculty of Medicine, Padjadjaran University, Bandung, West Java, Indonesia.
- 2Department of Obstetrics and Gynecology, Faculty of Medicine, Airlangga University, Surabaya, East Java, Indonesia.
Abstract
Purpose
Adenomyosis severity assessment remains challenging due to the lack of objective imaging parameters associated with underlying tissue characteristics. This study aimed to investigate the association between 3D transvaginal ultrasound-based XI VOCAL Counting severity and tissue MMP-9 levels in patients with adenomyosis.Patients and methods
This study employed an analytical observational design with a cross-sectional approach, focusing on adenomyosis patients who underwent surgery at Dr. Hasan Sadikin and Bandung Kiwari Hospitals. Diagnosis and severity were assessed using 3D transvaginal ultrasound-based XI VOCAL Counting, which quantifies transverse uterine sections showing MUSA direct signs, including subendometrial lines and buds, hyperechoic islands, and intramyometrial cysts. Tissue MMP-9 levels were measured by ELISA, and statistical analysis evaluated group differences and variable correlations, with significance set at p ≤ 0.05.Results
A total of 54 patients were included. XI VOCAL Counting severity was positively associated with tissue MMP-9 levels. The correlation was moderate during the proliferative phase (r = 0.680) and stronger during the secretory phase (r = 0.814; p < 0.001).Conclusion
XI VOCAL Counting severity was positively associated with tissue MMP-9 levels in patients with adenomyosis, with a stronger association observed during the secretory phase. These findings suggest that XI VOCAL Counting may provide a potential imaging-based severity assessment associated with molecular characteristics related to extracellular matrix remodeling. Further prospective multicenter studies are required to validate its reproducibility, clinical utility, and association with clinical outcomes.
Related
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- Visualising uterine microcirculation using contrast-enhanced ultrasound for differentiating between healthy controls and participants with adenomyosis: rationale and design of the UteroVue Adenomyosis study.
BibTeX
@article{christina2026association,
title = {{Association Between 3D Transvaginal Ultrasound-Based XI VOCAL Counting Severity and Tissue MMP-9 Levels in Patients with Adenomyosis.}},
author = {Ni Luh Lany Christina and Hartanto Bayuaji and Mulyanusa Amarullah Ritonga and Ruswana Anwar and Anita Rachmawati and Dian Tjahyadi and Sri Ratna Dwiningsih},
journal = {International journal of women's health},
year = {2026},
month = oct,
doi = {10.2147/ijwh.s629457},
url = {https://europepmc.org/article/MED/42910251},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Association Between 3D Transvaginal Ultrasound-Based XI VOCAL Counting Severity and Tissue MMP-9 Levels in Patients with Adenomyosis.
AU - Ni Luh Lany Christina
AU - Hartanto Bayuaji
AU - Mulyanusa Amarullah Ritonga
AU - Ruswana Anwar
AU - Anita Rachmawati
AU - Dian Tjahyadi
AU - Sri Ratna Dwiningsih
PY - 2026
DA - 2026/10/17
JO - International journal of women's health
DO - 10.2147/ijwh.s629457
UR - https://europepmc.org/article/MED/42910251
AB - Purpose Adenomyosis severity assessment remains challenging due to the lack of objective imaging parameters associated with underlying tissue characteristics. This study aimed to investigate the association between 3D transvaginal ultrasound-based XI VOCAL Counting severity and tissue MMP-9 levels in patients with adenomyosis.Patients and methods This study employed an analytical observational design with a cross-sectional approach, focusing on adenomyosis patients who underwent surgery at Dr. Hasan Sadikin and Bandung Kiwari Hospitals. Diagnosis and severity were assessed using 3D transvaginal ultrasound-based XI VOCAL Counting, which quantifies transverse uterine sections showing MUSA direct signs, including subendometrial lines and buds, hyperechoic islands, and intramyometrial cysts. Tissue MMP-9 levels were measured by ELISA, and statistical analysis evaluated group differences and variable correlations, with significance set at p ≤ 0.05.Results A total of 54 patients were included. XI VOCAL Counting severity was positively associated with tissue MMP-9 levels. The correlation was moderate during the proliferative phase (r = 0.680) and stronger during the secretory phase (r = 0.814; p < 0.001).Conclusion XI VOCAL Counting severity was positively associated with tissue MMP-9 levels in patients with adenomyosis, with a stronger association observed during the secretory phase. These findings suggest that XI VOCAL Counting may provide a potential imaging-based severity assessment associated with molecular characteristics related to extracellular matrix remodeling. Further prospective multicenter studies are required to validate its reproducibility, clinical utility, and association with clinical outcomes.
SN - 1179-1411
ER -