Uterine junctional zone and adenomyosis: comparison of <scp>MRI</scp>, transvaginal ultrasound and histology

Harmsen, Marissa J.; Trommelen, L M; Leeuw, Robert de; Tellum, Tina; Juffermans, Lynda J.M.; Thomassin‐Naggara, Isabelle; Bosch, T. Van den; Huirne, Jaf

doi:10.1002/uog.26117

Cited by 23 publications

(14 citation statements)

References 90 publications

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“…The sub-endometrial halo and the MRI image are distinct entities, differing from the outer myometrium by their increased nuclear density and vascular structure ( Tetlow et al, 1999 ). Although the signal intensity on MRI shows a clear delineation with the outer myometrium, by histology, a strict zonation between the two entities cannot be identified ( Harmsen et al, 2022 ; Mehasseb et al, 2011 ).…”

Section: What Is Known?mentioning

confidence: 95%

“…Images of the JZ are described as regular, irregular, interrupted, and not visible in a coronal plane with hyperechogenic sub- endometrial lines or buds and hyperechogenic spots. A recent publication ( Harmsen et al, 2022 ) described the discrepancies in JZ thickness seen at MRI and TVUS in the same patients with a thicker JZ if measured with MRI. JZ thickness was measured as one-third of the myometrium using MRI compared to a quarter using TVS, with the highest discrepancies seen at the luteal phase.…”

Section: What Is Known?mentioning

confidence: 99%

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Junctional zone thickening: an endo-myometrial unit disorder

Gordts,

Grimbizis,

Tanos

et al. 2023

Facts Views Vis ObGyn

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Adenomyosis is a disease defined by histopathology, mostly of hysterectomy specimens, and classification is challenged by the disagreement of the histologic definition. With the introduction of Magnetic Resonance Imaging (MRI) and two- and three-dimensional ultrasound, the diagnosis of adenomyosis became a clinical entity. In MRI and US, adenomyosis ranges from thickening of the inner myometrium or junctional zone to nodular, cystic, or diffuse lesions involving the entire uterine wall, up to a well-circumscribed adenomyoma or a polypoid adenomyoma. The absence of an accepted classification and the vague and inconsistent terminology hamper basic and clinical research. The sub-endometrial halo seen at US and MRI is a distinct entity, differing from the outer myometrium by its increased nuclear density and vascular structure. The endometrium and the sub-endometrial muscularis or archimetra are of Müllarian origin, while the outer myometrium is non-Mullerian mesenchymal. The junctional zone (JZ) is important for uterine contractions, conception, implantation, and placentation. Thickening of the JZ can be considered inner myometrium adenomyosis, with or without endometrial invasion. Changes in the JZ should be considered a different entity than myometrial clinically associated with impaired conception, implantation, abnormal uterine bleeding, pelvic pain and obstetrical outcome. Pathology of the basal endometrium and JZ is a separate entity and should be identified as an endo-myometrial unit disorder (EMUD).

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Section: What Is Known?mentioning

confidence: 95%

Section: What Is Known?mentioning

confidence: 99%

Junctional zone thickening: an endo-myometrial unit disorder

Gordts,

Grimbizis,

Tanos

et al. 2023

Facts Views Vis ObGyn

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“…The third hypothesis states that fibroids possibly disturb the frequency, direction, amplitude, and coordination of junctional zone peristalsis resulting in inadequate oocyte and sperm transport. The contractility of the subendometrial layer or inner myometrium in a non-pregnant uterus moves in specific patterns and directions depending on the phase of the menstrual cycle, also known as junctional zone peristalsis ( Harmsen etal. , 2022 ).…”

Section: Disturbed Oocyte and Sperm Transport And Detrimental Environ...mentioning

confidence: 99%

Infertility in patients with uterine fibroids: a debate about the hypothetical mechanisms

Don,

Mijatovic,

Huirne

2023

Human Reproduction

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Fibroids are benign tumours of the myometrium and are the most common gynaecologic abnormality. Although most fibroids are asymptomatic, they can cause symptoms like heavy menstrual bleeding, pelvic pain, sexual dysfunction, pressure complaints, and infertility. The association between fibroids and infertility has been debated for decades. It is generally acknowledged that the closer the fibroid is to the uterine cavity and the endometrium lining, the more unfavourable effect it might have on fertility, reducing the odds for successful implantation and gestation. Based on the limited available literature, we propose and discuss seven hypotheses on the underlying mechanism by which fibroids may reduce fertility. (i) Fibroids can cause sexual dysfunction, as fibroids can cause dyspareunia, pelvic pain, and prolonged and heavy menstrual bleeding, which could interfere with sexual arousal and as a consequence the frequency of intercourse, resulting in a reduced probability of conception. (ii) Mechanical compression by fibroids on theinterstitial part of the fallopian tubes or deformation of uterine cavity could disturb oocyte and sperm transport. (iii) Fibroids can disturb peristalsis of the junctional zone in the myometrium, which could negatively influence oocyte and sperm transport as well as implantation. In addition, fibroids could induce a detrimental environment for implantation in other ways, by: (iv) changing the vagino-uterine microbiome; (v) disturbing the levels of inflammation and autophagy; (vi) inducing molecular changes in the endometrium; and (vii) inducing aberrant angiogenesis and altering the endometrial blood supply. After the discussion of these hypotheses, the implication of the influence of fibroids on early pregnancy loss is discussed. Surgical fibroid treatment is not tailored nor focussed on the pathophysiology of the fibroid; consequently it may be accompanied by recurrence of fibroids and risks of complications. Unravelling the pathogenic mechanisms about how fibroids influence fertility is essential to evolve classic surgical fibroid treatment. Instead of treatment of fibroid-related symptoms, the research should supports development of fibroid-targeted (pharmaceutical) treatment that is compatible with an active wish to become pregnant.

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“…MRI of the uterus is a second-line examination for the diagnosis of adenomyosis, especially in cases of inconclusive ultrasound evaluation or as a preoperative measure prior to surgical intervention. An MRI can also distinguish between subtypes of adenomyosis, and more precisely differentiate between adenomyosis and fibroids than TVS [ 32 , 33 ]. The JZ shows fluctuations in thickness depending on hormone levels.…”

Section: Diagnosis Of Adenomyosismentioning

confidence: 99%

Impact of Adenomyosis on Infertile Patients—Therapy Options and Reproductive Outcomes

Allahqoli

Gitas²,

Maass

et al. 2022

Biomedicines

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Adenomyosis is associated with a negative impact on reproductive outcomes. Although adenomyosis is detected more frequently in women of late reproductive age, its impact on pregnancy rates is important because, in today’s world, family planning has shifted towards the late reproductive phase of life for many women. Although the diagnostic indications for imaging studies are well-known, we lack strict diagnostic criteria and classification systems concerning the extent of the disease. Selecting the optimal evidence-based treatment option for adenomyosis is difficult because of the paucity of evidence concerning the association between fertility and the degree and composition of adenomyosis. Furthermore, the treatment of infertility might interfere with the treatment of adenomyosis due to the presence of pain. The aim of this review is to analyze the association between adenomyosis and infertility, and describe treatment options to enhance reproductive outcomes. The following aspects will be addressed in detail: (a) prevalence and causes of adenomyosis, (b) diagnostic tools with imaging techniques, (c) clinical symptoms, (d) proposed pathomechanism of adenomyosis and infertility, and (e) different treatment approaches (pharmacological, surgical, others) and their impact on reproductive outcomes.

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Uterine junctional zone and adenomyosis: comparison of MRI, transvaginal ultrasound and histology

Abstract: This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process which may lead to differences between this version and the Version of Record. Please cite this article as

Cited by 23 publications

References 90 publications

Junctional zone thickening: an endo-myometrial unit disorder

Junctional zone thickening: an endo-myometrial unit disorder

Infertility in patients with uterine fibroids: a debate about the hypothetical mechanisms

Impact of Adenomyosis on Infertile Patients—Therapy Options and Reproductive Outcomes

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