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ECR 2019 / C-3508
Adenomyosis and MRI
Congress: ECR 2019
Poster No.: C-3508
Type: Educational Exhibit
Keywords: Pelvis, Genital / Reproductive system female, Anatomy, MR, Ultrasound, CT, Education, Image compression, Perception image, Hyperplasia / Hypertrophy, Cysts, Dilatation
Authors: J. Murillo1, D. STOISA2, R. L. Villavicencio2; 1Tegucigalpa, FM/HN, 2Rosario/AR
DOI:10.26044/ecr2019/C-3508

Findings and procedure details

AETHIOLOGY

 

  • Still not fully understood.
  • Various theories have been proposed:

Exposure to aestrogen.

Parity.

Prior uterine surgery. 

  • Most frequently in postmenopausal women, although evidence points that beginsduring women’s fertile age.
  • Rare in adolescence (except for cystic adenomyosis).

 

 

DIAGNOSIS

 

  • Clincical diagnosis is difficult (non specific manifestations)

1/3 Asymptomatic.

2/3 Menorrhagia, dysmenorrhea, pelvic pain and uterine enlargement.               

  • TVUS and MRI are the main imaging tools.
  • MRI diagnostic accuracy: 85%.
  • The thickness of the junctional zone (JZ) is the most frequent MRI criterion for the diagnosis.

JZ thickness > 12 mm is highly predictive of  adenomyosis.     

JZ thickness < 8 mm excludes the disease.

JZ thickness between 8-12mm look for secondary signs.

 

  Fig. 2

Fig. 2
References: Department of Radiology , Diagnostico Medico Oroño, Fundación Villavicencio. Rosario, Argentina.

 

 

MRI SEQUENCES

 

  • HR T2-WI sagittal, axial and coronal planes:

             Uterine zonal anatomy.

          Thickness of the JZ.

          Presence of dilated glands and cysts.

          Differentiate focal and diffuse presentations. 

 

  • T1 3D fat-suppressed axial and sagittal planes:

           Depict high-signal intensity foci of haemorrhage.

 

Fig. 3 

Fig. 3
References: Department of Radiology , Diagnostico Medico Oroño, Fundación Villavicencio. Rosario, Argentina.

 

 

TO BE CONSIDERED

 

  • Preferably, MRI should be performed in the late proliferative phase, avoiding the menstrual phase as thickness of JZ is hormone-dependent and changes with the menstrual cycle.

The uterus during menstruation may demonstrate marked thickening of the junctional zone, mimicking adenomyosis.  

  • Administration of hyoscine may be helpful.

Transient uterine contractions appear as T2-WI hypointense bands perpendicular to the JZ or focal thickening of the JZ, mimicking focal adenomyosis. 

  • Postmenopausal condition and use of contraceptives drugs affect  the JZ.

 

 

USUAL PRESENTATION OF ADENOMYOSIS

 

  • Diffuse: foci of adenomyosis are distributed throughout the uterus. 
  • Focal: when affects a limited area.

 

  Fig. 4 

Fig. 4
References: Department of Radiology , Diagnostico Medico Oroño, Fundación Villavicencio. Rosario, Argentina.

 

 

UNUSUAL PRESENTATION OF ADENOMYOSIS

 

  • Adenomyoma: localized confluence of adenomyotic glands, forming a mass-like form of adenomyosis, most commonly in corpus uteri.
  • Polypoid adenomyoma: when a mas-like form of adenomyosis bulges into the endometrium.
  • Cystic adenomyoma: intramural, submucosal or subserosal large haemorrhagic cyst. 
  • Swiss-cheese appearance: large dilated endometrial glands within the miometrium.

 

Fig. 5 

Fig. 5
References: Department of Radiology , Diagnostico Medico Oroño, Fundación Villavicencio. Rosario, Argentina.

 

 

Fig. 6

Fig. 6
References: Department of Radiology , Diagnostico Medico Oroño, Fundación Villavicencio. Rosario, Argentina.

 

 

Fig. 7 

Fig. 7
References: Department of Radiology , Diagnostico Medico Oroño, Fundación Villavicencio. Rosario, Argentina.

 

 

Fig. 8 

Fig. 8
References: Department of Radiology , Diagnostico Medico Oroño, Fundación Villavicencio. Rosario, Argentina.

 

 

ASSOCIATED CONDITIONS 

 

  • Leiomyomas: are present in almost one half of cases of adenomyosis.
  • Endometriosis: about 1/3 of young women with clinical suspicion of infiltrating deep endometriosis develop uterine adenomyosis. This pathology seems to be correlated with adenomyosis.
  • Endometrial polyp/ endometrial hyperplasia: Adenomyosis is significantly associated with endometrial and cervical polyps.

 

  Fig. 9

 

Fig. 9
References: Department of Radiology , Diagnostico Medico Oroño, Fundación Villavicencio. Rosario, Argentina.

 

 

Fig. 10

 

Fig. 10
References: Department of Radiology , Diagnostico Medico Oroño, Fundación Villavicencio. Rosario, Argentina.

 

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