Table 1.

Overview of the studies on USE in diagnosing UF and UM

Year	Authors	Patient numbers and type of lesions	Type of elastography	Type of study	Diagnostic parameters	Diagnostic performance or research results
Assessment of the normal uterus
2019	Manchanda et al. [58]	NM = 56	SWE	Prospective cohort study	E mean	The E mean was 25.54 ± 8.56 (endometrium), 40.24 ± 8.59 (myometrium), and 18.90 ± 4.22 (cervix). There was no significant difference in E mean for women in different menstrual phases (p = .176) or in different age groups (p = .376)
2015	Soliman et al. [57]	NM = 32	ARFI	Prospective observational study	Cs mean	The menopausal status did not have any significant influence on the Cs measurements. The Cs means were 2.05 ± 0.77 m/s (endometrium) while 2.82 ± 0.77 m/s(myometrium)
Lesions of the uterus
2022	Pongpunprut et al. [33]	NM = 25, UF = 25, AM = 25	SWE	Prospective cross-Sectional Study	Cs mean	The Cs differed between NM and AM (p = 0.019) with the cut-off point at 3.465 m/s and 80% sensitivity, 80% specificity, and AUC of 0.80 (95% CI 0.68–0.93) (p < 0.001). SWE could not differentiate AM from UF or UF from NM
2021	Görgülü et al. [34]	UF = 98, AM = 37 NM = 40	SWE, SE and MRI ADC	Retrospectively case–control study	SR mean, SR max, ADC values, Cs mean, and Cs max	SE, SWE, and MRI ADC could be useful in differentiating UF and AM (p < 0.001 for all three), and none of these methods were statistically superior to each other in differentiating the UF from the AM (p < 0.001)
2019	Zhang et al. [49]	NM = 16, UF = 12, AM = 6	SWE	Prospective case–control study	Cs mean	Cs mean in NM was 4.861.9 m/s, compared with 4.962.5 m/s in AM and 5.662.5 m/s in UF (p = 0.34). SWV for AM and UF did not differ significantly (p = 0.40)
2018	Bildaci et al. [29]	AM = 28, NM = 62	vitro ARFI	Prospective case–control study	Cs mean	The Cs mean of AM (4.22 ± 1.62 m/s) showed a significant difference compared to that of NM (3.22 ± 0.90 m/s) (p < 0.01)
2018	Stoelinga et al. [30]	NM = 10, UF = 10, AM = 10	SE	Prospective diagnostic study	Uterine volume for AM and fibroid volume for AF	The sensitivity of SE in the diagnosis of UF and AM was 82% and 91%, and the specificity was 95% and 97% with high inter-observer and inter-method agreement
2018	Liu et al. [32]	NM = 141, UF = 75, AM = 147	SE	Prospective control study	SR mean, SR max, SR min	The stiffness of AM lesions was significantly higher than that of UF (p < 0.01)
2016	Frank et al. [31]	NM = 143, UF = 41, AM = 22	SE	Prospective case–control study	SR max: stored as the “lesion index”	“Lesion indices” of UF, AM, and NM were 2.65, 0.44, and 1.19, respectively, and were significantly different between them (p < 0.001)
Assessment of treatment
2020	Samanci et al. [36]	UF = 33	SWE	Prospective case–control study	Cs mean	The post-UAE Cs mean of UF (3.34 ± 3.9 kPa) was significantly lower than that of the pre-UAE (17.16 ± 4.8 kPa) (p < 0.001). There was excellent agreement between the 2 blinded observers in Cs mean
2019	Xie et al. [35]	AM = 45	SE	Prospective case–control study	scoring system	In 12 cases who were pregnancy during the follow-up, the mean elasticity score was significantly higher for the uterine after therapy than before (3.6 ± 0.3 vs 2.3 ± 0.5, p = 0.004)

USE ultrasound elastography, NM normal myometrium, SE strain elastography, SWE shear wave elastography, E Young’s modulus, Cs shear wave speed, MRI ADC magnetic resonance imaging apparent diffusion coefficient values, UF uterine fibroids, UAE uterine artery embolization, AUC area under the curve, ARFI acoustic radiation force imagine, AM adenomyosis, SR mean strain ratio mean, SR max strain ratio maximum, SR min strain ratio minimum. References were presented in Supplementary text