The Significance of MRI Evaluation of the Uterine Junctional Zone in the Early Diagnosis of Adenomyosis

Abstract

Goal:The aim of the study is to define the MRI appearance of disorder in the Junctional zone (JZ) in women with adenomyosis compared to those without it, given the importance of the JZ in the regulation of various reproductive events.Materials and methods:This was a prospective, comparative and open study. Patients with adenomyosis have been sorted in target group, n = 82, while the control group consisted of patients without adenomyosis, n = 82. All patients, from both groups have undergone a magnetic resonance imaging of the pelvis. Using a software tool for measurement, the thickness of the JZ was measured in T2w sag sequences in all patients from both groups (target and control) n = 164. Patients in the target group type adenomyosis were assessed and categorized either as: diffuse, focal, or Adenomyoma and the results were compared. The presence of endometriosis and myomas in both groups was evaluated and its coexistence with adenomyosis was analyzed as well.Results:Of the 82 patients in the target group, 81.7% of the patients had diffuse adenomyosis, while 18.3% had focal type with statistically significant difference (p <0.05). The results of the Mann-Whitney U test showed that p <0.05, implying that there is a statistically significant difference in the thickness of the JZ between the control and target group, therefore patients from the target group with adenomyosis had a statistically significantly thicker junctional zone than the patients in the control group. The JZ in the target group was on average M = 14,3mm, SD = 1.3mm, while the thickness of JZ in the control group without adenomyosis was M = 5,6mm, SD = 1,3. Chi-square shows that p <0.05, implying that there is a statistically significant difference in the number of patients with myomas between the two groups, where the myomas significantly over-represented in the target group with 32,9 % vs.6 %).Conclusion:MRI is the method of choice for imaging and evaluation of JZ as an important diagnostic marker in the diagnosis of adenomyosis. It is important to recognize this condition as early as possible and distinguish it from other pathologies in order for timely and appropriate treatment.

Complications and outcomes of pregnant women with adenomyosis in Japan

“…Previous reports have also shown that diffuse‐type adenomyosis is more common than focal‐type adenomyosis. In one study, the prevalence of diffuse‐type and focal‐type adenomyosis was 81.7% and 18.3%, respectively, in another, it was 66.7% and 33.3%, respectively . In the present survey, 58.2% (138/237) of the pregnancies involved diffuse‐type adenomyosis.…”

Clinical outcomes of infertility treatment for women with adenomyosis in Japan

“…As many women delay seeking conception, they are more commonly diagnosed with adenomyosis during the later stages of reproductive age . Recent advances in imaging methods using transvaginal ultrasonography and magnetic resonance imaging (MRI) have enabled a more detailed evaluation of the uterine muscle for the diagnosis of women with adenomyosis …”

The abnormal expression of oxytocin receptors in the uterine junctional zone in women with endometriosis

“…Endometriosis and adenomyosis came to be seen as distinct entities. MRI is the method of choice for imaging and evaluation of JZ as an important diagnostic marker in the diagnosis of adenomyosis [19]. Because adenomyosis can be confidently diagnosed using MRI when the altered junctional zone thickness is greater than 12 mm and the expression pattern of oxytocin receptor in the junctional zone in women with adenomyosis had been studied by Zhang, women with evidence of adenomyosis were excluded from the scope of this study [20, 21].…”