Adenomyosis and MRI: What you need to know and be aware of

Pelvis, MR, Diagnostic procedure, Education and training Authors: L. I. R. Agostinho1, R. Cruz2, A. Guerra3, M. J. M. Barata3, A. Setubal1; 1Lisbon/PT, 2Loures/PT, 3Lisboa/PT DOI: 10.1594/ecr2016/C-1192 Learning objectives The purpose of our poster is to: Illustrate the usual and unusual MRI appearances of adenomyosis, main differential diagnosis and associated conditions. Demonstrate the pitfalls which one must be aware of.

Adenomyosis is a common benign gynecological disorder defined by the presence of ectopic endometrial glands and stroma within the myometrium. It is a disease of the archimetra or inner myometrium and results from infiltration of the basal endometrium into the underlying myometrium, with subsequent hypertrophy and hyperplasia of smooth muscle. Clinical diagnosis is usually not possible because of the nonspecific nature of symptoms, such as dysmenorrhea and menorrhagia and the frequent coexistence of other pelvic diseases. Transvaginal ultrasonography and MRI are the main radiologic tools... Findings and procedure details 1. PATHOLOGY Histopathological criteria for the diagnosis includes the presence of ectopic endometrial tissue within the myometrium located 2.5 mm beyond the endometrial-myometrial junction (Fig. 1). On gross pathology there is (Fig. 2): A usually firm, enlarged and globular uterus. Hypertrophy of myometrial smooth muscle. Etopic endometrium, dilated endometrial glands and cysts/haemorrhage. 2. MRI FEATURES Adenomyosis appears as a thickening of the junctional zone forming an ill-defined area of low signal intensity, frequently with bright foci on T2-weighted images. It is mainly located in the...

MRI represents an accurate evaluation tool for adenomyosis not only for its diagnosis but also for detecting associated pathologies. It can be recommended for the diagnosis of adenomyosis when associated pathologies are suspected. Itis important to recognizethe usual and unusualcharacteristics of adenomyosis and be aware of some pitfalls in order to make a correctdiagnosis.

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