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      MRI for adenomyosis: a pictorial review

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          Abstract

          Abstract

          Adenomyosis is defined as the presence of ectopic endometrial glands and stroma within the myometrium. It is a disease of the inner myometrium and results from infiltration of the basal endometrium into the underlying myometrium. Transvaginal ultrasonography (TVUS) and magnetic resonance imaging (MRI) are the main radiologic tools for this condition. A thickness of the junctional zone of at least 12 mm is the most frequent MRI criterion in establishing the presence of adenomyosis. Adenomyosis can appear as a diffuse or focal form. Adenomyosis is often associated with hormone-dependent lesions such as leiomyoma, deep pelvic endometriosis and endometrial hyperplasia/polyps. Herein, we illustrate the MRI findings of adenomyosis and associated conditions, focusing on their imaging pitfalls.

          Teaching points

          • Adenomyosis is defined as the presence of ectopic endometrium within the myometrium.

          • MRI is an accurate tool for the diagnosis of adenomyosis and associated conditions.

          • Adenomyosis can be diffuse or focal.

          • The most established MRI finding is thickening of junctional zone exceeding 12 mm.

          • High-signal intensity myometrial foci on T2- or T1-weighted images are also characteristic.

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          Most cited references36

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          Adenomyosis in endometriosis--prevalence and impact on fertility. Evidence from magnetic resonance imaging.

          P. Huppert, D Beil, M Noe … (2005)
          The hypothesis is tested that there is a strong association between endometriosis and adenomyosis and that adenomyosis plays a role in causing infertility in women with endometriosis. METHODS. Magnetic resonance imaging of the uteri was performed in 160 women with and 67 women without endometriosis. The findings were correlated with the stage of the disease, the age of the women and the sperm count parameters of the respective partners. The posterior junctional zone (PJZ) was significantly thicker in women with endometriosis than in those without the disease (P<0.001). There was a positive correlation of the diameter of the PJZ with the stage of the disease and the age of the patients. The PJZ was thicker in patients with endometriosis with fertile than in patients with subfertile partners. The prevalence of adenomyotic lesions in all 160 women with endometriosis was 79%. In women with endometriosis below an age of 36 years and fertile partners, the prevalence of adenomyosis was 90% (P<0.01) With a prevalence of up to 90%, uterine adenomyosis is significantly associated with pelvic endometriosis and constitutes an important factor of sterility in endometriosis presumably by impairing uterine sperm transport.
          Article 0 comments Cited 65 times – based on 0 reviews     Review now
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            Ultrasonography compared with magnetic resonance imaging for the diagnosis of adenomyosis: correlation with histopathology.

            Lisa A. Cortez, J Rouger, E Daraï … (2001)
            The objective of this study was to compare the accuracy of transabdominal (TAUS) and transvaginal sonography (TVUS) and magnetic resonance imaging (MRI) for the diagnosis of adenomyosis, and to correlate imaging with histological findings. In a prospective study, 120 consecutive patients referred for hysterectomy underwent TAUS, TVUS and MRI. Results of these examinations were interpreted blindly to histopathological findings. Histological prevalence of adenomyosis and leiomyomas was 33.0 and 47.5% respectively. Adenomyotic uteri were accompanied by additional pelvic disorders in 82.5% of cases. Sensitivity, specificity, and positive and negative predictive values of TAUS and TVUS were 32.5 and 65.0%, 95.0 and 97.5%, 76.4 and 92.8%, and 73.8 and 88.8% respectively. Myometrial cyst was the most sensitive and specific TVUS criterion. In MRI, the presence of a high-signal-intensity myometrial spot was as specific but less sensitive than a maximal junctional zone thickness (JZ(max)) >12 mm and a JZ(max) to myometrial thickness ratio >40%. Sensitivity, specificity, and positive and negative predictive values of MRI were 77.5, 92.5, 83.8 and 89.2% respectively. No difference in accuracy was found between TVUS and MRI, but sensitivity was lower with sonography in women with associated myomas. TVUS is as efficient as MRI for the diagnosis of adenomyosis in women without myoma, while MRI could be recommended for women with associated leiomyoma.
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              The pathophysiology of uterine adenomyosis: an update.

              Giuseppe Benagiano, Marwan Habiba, Ivo Brosens (2012)
              The diagnosis of adenomyosis using noninvasive techniques such as vaginal ultrasounds and magnetic resonance has clear clinical applications and has renewed the interest in the pathogenesis of uterine adenomyosis. However, the research remains hampered by the lack of consensus on the classification of lesions. Magnetic resonance imaging and transvaginal ultrasound have comparable diagnostic accuracy. Minimal interventional biopsy techniques have recently been introduced. This article reviews human and animal studies and provides an update on the pathophysiology of adenomyosis. Recent views on the pathogenesis and links with endometriosis are discussed.
              Article 0 comments Cited 45 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Lisa Agostinho: 00351912282404 , lisa.r.agostinho@gmail.com
                Journal
                Journal ID (nlm-ta): Insights Imaging
                Journal ID (iso-abbrev): Insights Imaging
                Title: Insights into Imaging
                Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )
                ISSN (Electronic): 1869-4101
                Publication date (Electronic): 4 October 2017
                Publication date PMC-release: 4 October 2017
                Publication date Collection: December 2017
                Volume: 8
                Issue: 6
                Pages: 549-556
                Affiliations
                [1 ]Department of Radiology, Hospital Beatriz Angelo, Loures, Portugal
                [2 ]ISNI 0000 0001 0163 5700, GRID grid.414429.e, Department of Gyneacology, , Hospital da Luz, ; Lisbon, Portugal
                [3 ]ISNI 0000 0001 0163 5700, GRID grid.414429.e, Department of Radiology, , Hospital da Luz, ; Lisbon, Portugal
                Article
                Publisher ID: 576
                DOI: 10.1007/s13244-017-0576-z
                PMC ID: 5707223
                PubMed ID: 28980163
                SO-VID: 50d5d87a-4653-4716-bcd1-296e536c8646
                Copyright © © The Author(s) 2017
                License:

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                Date received : 31 May 2017
                Date revision received : 26 August 2017
                Date accepted : 5 September 2017
                Categories
                Subject: Pictorial Review
                Custom metadata
                issue-copyright-statement © The Author(s) 2017

                ScienceOpen disciplines: Radiology & Imaging
                Keywords: adenomyosis · uterus · female urogenital diseases · magnetic resonance imaging · diagnostic imaging
                Data availability:
                ScienceOpen disciplines: Radiology & Imaging
                Keywords: adenomyosis · uterus · female urogenital diseases · magnetic resonance imaging · diagnostic imaging

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