Case 19

Discussion:

Adenomyosis is a benign disease of the uterus characterized by ectopic endometrial glands and stroma within the myometrium. It can be diffuse or focal. Adenomyosis occurs mainly in premenopausal women, particularly those who are multiparous. Pelvic ultrasound is commonly used as the initial imaging modality for patients with clinically suspected adenomyosis. The reported sensitivity and specificity of TAS are 32.5–63% and 95–97%, respectively. Typical appearances of adenomyosis at TVS include poorly marginated hypoechoic and heterogeneous areas within the myometrium, myometrial cysts, and a globular or enlarged uterus.

Magnetic resonance (MR) imaging is a highly accurate noninvasive modality for diagnosis. The diagnosis is typically made on high resolution T2WI. Adenomyosis appears as either diffuse or focal thickening of the junctional zone forming an ill-defined area of low signal intensity, occasionally with embedded bright foci on T2-WI corresponding to islands of ectopic endometrial tissue and cystic dilatation of glands. It has been proposed that a junctional zone thickness greater than 12 mm should further optimize the diagnostic accuracy of MR imaging.

References:

• Ken Tamai, MD, Kaori Togashi, MD, TsuyoshiIto, MD, Nobuko Morisawa, MD, Toshitaka Fujiwara, MD and Takashi Koyama, MD. MR Imaging Findings of Adenomyosis: Correlation with Histopathologic Features and Diagnostic Pitfalls. RadioGraphics 2005;25:21-40
• Jae Young Byun, MD, Sung Eun Kim, MD, Byung Gil Choi, MD, Gi Young Ko, MD, Seung Eun Jung, MD and Kyu Ho Choi, MD. Diffuse and Focal Adenomyosis: MR Imaging Findings. RadioGraphics. 1999; 19:S161-S170.