Adenomyosis: diagnosis with MR imaging.

Abstract

Magnetic resonance (MR) imaging characteristics of adenomyosis were studied in eight women (aged 37-49 years) who underwent hysterectomy, and detailed radiologic/pathologic correlation was conducted in all cases. Adenomyosis produced diffuse and smooth uterine enlargement. The extent of the lesion was clearly identified on images obtained with long repetition time and long echo time; a diffuse, low-intensity area accompanied by tiny high-intensity spots was seen subjacent to the endometrium. The area appeared as a localized or diffuse thickening of the junctional zone because it was often isointense with this zone. Pathologic examination confirmed that the extent of adenomyosis correlated well with the low-intensity region on MR images and that both hemorrhagic areas and nonbleeding endometrial tissue corresponded to the high-intensity spots. The lesion consisted of distorted and compacted smooth muscle cells, but microscopic studies failed to explain the definitive difference in intensity between areas of adenomyosis and myometrium.

Patients with adenomyosis are more likely to have deep endometriosis

“…This became feasible and MRI is currently considered to be a highly accurate tool for the diagnosis of this pathology [7,11,12,14,28]. The radiological criteria selected in the present study for the diagnosis of adenomyosis were those most generally accepted in the literature: thickness of the junctional zone ≥12 mm and the presence of intramyometrial cysts, regions of hyperintense signals surrounded by an area of low intensity signals and poorly defined borders on T2-weighted sequences [5,14,[19][20][21]. In the 152 patients with a diagnosis of endometriosis in the present study, critical analysis of their MRI scans revealed that 65 patients (42.8 %) had a diagnosis of adenomyosis.…”

“…MRI represents an accurate method for the detection of adenomyosis, sensitivity, and specificity varying from 86 % to 100 % [5,14,[18][19][20][21][22], making this a highly effective tool for the diagnosis of this disease [14].…”

Uterine Adenomyosis: Endovaginal US and MR Imaging Features with Histopathologic Correlation

“…Several studies have demonstrated MR imaging to be highly accurate in diagnosis of adenomyosis, with a sensitivity and specificity of 86%-100% and an overall accuracy of 85%-90.5% (5,6,(11)(12)(13)(14).…”

“…Muscular hypertrophy may demonstrate a hypoechoic inner myometrium at endovaginal US and diffuse junctional zone thickening at MR imaging, thus mimicking the appearance of adenomyosis. Cystic adenomyosis may be mistaken for a leiomyoma with hemorrhagic degeneration or a hematometra within a noncommunicating uterine segment (Figs 13,14). .…”

Imaging features of adenomyosis

“…In addition, the presence of mural leiomyomas can limit the assessment of the adjacent myometrium with EVS. Several studies have demonstrated MR imaging to be highly accurate in diagnosing adenomyosis, with a sensitivity and specificity ranging from 86 to 100% (Mark et al, 1987;Togashi et al, 1988;Togashi et al, 1989;Hricak et al, 1992;Ascher et al, 1994;Reinhold et al, 1996). However, the high cost and limited availability of MR imaging makes it an impractical tool for the initial evaluation of all patients with symptoms suggestive of adenomyosis, as these are non-specific and are the presenting complaints for a large proportion of the gynaecological population.…”