Enlarged uterus: differentiation between adenomyosis and leiomyoma with MR imaging.

Togashi, Kaori; Okumura, Hiroshi; Konishi, Ikuo; Itoh, Harumichi; Nishimura, K; Fujisawa, Ichiro; Noma, Satoshi; Sagoh, T; Minami, S; Yamashita, Keiji

doi:10.1148/radiology.171.2.2704819

Cited by 236 publications

(119 citation statements)

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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Patients with adenomyosis are more likely to have deep endometriosis

et al. 2012

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This study seeks to analyze the association between adenomyosis diagnosed by magnetic resonance imaging (MRI) and endometriosis. This is a prospective study of consecutive patients. One hundred fifty-two patients with histologically confirmed endometriosis. Patients were submitted to MRI, then divided into Group A (with adenomyosis) and Group B (without adenomyosis). Thickness of the junctional zone and the presence of intramyometrial cysts were the principal criteria for diagnosis of adenomyosis. MRI data were correlated with clinical status, staging, sites affected, and histological classification of endometriosis. The prevalence of adenomyosis in endometriosis patients was 42.76 %. Patients with endometriosis and adenomyosis were more likely than those without adenomyosis to report severe or incapacitating dysmenorrhea (61.53 % in Group A; 44.83 % in Group B; p00.041) and deep dyspareunia (64.61 % in Group A; 41.38 % in Group B; p00.005), to have stage IV endometriosis (50.77 % in Group A; 33.34 % in Group B; p00.03), to have endometriosis of the rectosigmoid (49.23 % in Group A; 32.18 % in Group B; p00.033), and to have undifferentiated or mixed histological types of endometriosis (52.31 % in Group A; 34.48 % in Group B; p00.028). A correlation was found between adenomyosis and deep endometriosis with poorer prognosis, particularly endometriosis of the rectosigmoid.

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Section: Discussionmentioning

confidence: 99%

“…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].…”

Section: Introductionmentioning

confidence: 99%

Patients with adenomyosis are more likely to have deep endometriosis

et al. 2012

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“…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).…”

Section: Accuracy Of Diagnosismentioning

confidence: 99%

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

Reinhold¹,

Tafazoli²,

Mehio³

et al. 1999

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Uterine adenomyosis is a common gynecologic condition that is characterized by the presence of heterotopic endometrial glands and stroma in the myometrium with adjacent smooth muscle hyperplasia. The histopathologic features of adenomyosis are varied and contribute to its imaging appearance. The accompanying smooth muscle hyperplasia produces the typical gross appearance of adenomyosis and corresponds to areas of decreased echogenicity at endovaginal ultrasonography (US) and areas of decreased signal intensity at magnetic resonance (MR) imaging. Endovaginal US also shows heterogeneity of the myometrial echotexture, which corresponds to small echogenic islands of heterotopic endometrial tissue surrounded by the hypoechoic smooth muscle. On T2-weighted MR images, bright foci are seen in areas of abnormal low signal intensity within the myometrium in approximately 50% of patients. These foci correspond to islands of heterotopic endometrial tissue, cystic dilatation of heterotopic glands, or hemorrhagic foci. With the advent of high-resolution imaging techniques, signs associated with the presence of heterotopic endometrial tissue are being detected with increasing frequency. These signs include myometrial cysts, myometrial nodules, linear striations, pseudowidening of the endometrium, and poor definition of the endomyometrial junction. Pitfalls in diagnosis of uterine adenomyosis include leiomyoma, endometrial carcinoma, myometrial contractions, and muscular hypertrophy.

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“…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.…”

Section: Magnetic Resonance Imagingmentioning

confidence: 99%