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.