Benign Myometrial Conditions: Leiomyomas and Adenomyosis

Ascher SM, Susan M. Ascher, Reena Jha, Reena C Jha, Jha RC, Reinhold C, Caroline Reinhold
Topics in magnetic resonance imaging : TMRI · 2003 · vol. 14(4) , pp. 281–304 · doi:10.1097/00002142-200308000-00003 · PMID:14578775 · W2074533801
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Magnetic resonance imaging accurately diagnoses uterine leiomyomas and adenomyosis by identifying lesion number, size, and location, guiding therapeutic decisions for these common benign myometrial conditions.

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This review examines the clinical distinction between leiomyomas and adenomyosis, two common benign myometrial conditions that share overlapping symptoms but require different therapeutic approaches. Magnetic resonance imaging is identified as the most accurate diagnostic modality for both entities, with T2-weighted sequences typically providing sufficient information to determine lesion number, size, and location without the need for intravenous gadolinium contrast. The authors note that while hysterectomy remains the standard curative treatment for debilitating adenomyosis, uterine-conserving therapies are well-established for many patients with symptomatic leiomyomas, making precise diagnosis critical for appropriate patient triage. This paper is centrally about adenomyosis — specifically its differential diagnosis from leiomyomas using MRI to guide treatment selection between uterine preservation and hysterectomy.

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Abstract

Leiomyomas and adenomyosis are common benign myometrial conditions. Although their symptoms overlap, traditional treatment of these two entities differs; thus, making the correct diagnosis is critical. Specifically, uterine-conserving therapy is well established for many women with symptomatic leiomyomas, whereas hysterectomy is the treatment for debilitating adenomyosis. Magnetic resonance imaging (MRI) is the most accurate modality for identifying leiomyomas and adenomyosis. T2-weighted sequences often are diagnostic. For leiomyomas, MRI reliably identifies their number, size, and location. These features help triage patients to appropriate therapy. For adenomyosis, MRI establishes the diagnosis in cases of equivocal or nondiagnostic ultrasounds. MRI also has been used to confirm an ultrasound diagnosis of adenomyosis when curative surgery is being considered. Intravenous gadolinium chelates are not necessary to make the diagnosis of either adenomyosis or leiomyomas, but it provides useful information about vascularity of lesions, a factor that may impact the type of treatment undertaken.
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Benign Myometrial Conditions: Leiomyomas and Adenomyosis - Susan M. Ascher - Reena C. Jha - Caroline Reinhold Summary: Leiomyomas and adenomyosis are common benign myometrial conditions. Although their symptoms overlap, traditional treatment of these two entities differs; thus, making the correct diagnosis is critical. Specifically, uterine-conserving therapy is well established for many women with symptomatic leiomyomas, whereas hysterectomy is the treatment for debilitating adenomyosis. Magnetic resonance imaging (MRI) is the most accurate modality for identifying leiomyomas and adenomyosis. T2-weighted sequences often are diagnostic. For leiomyomas, MRI reliably identifies their number, size, and location. These features help triage patients to appropriate therapy. For adenomyosis, MRI establishes the diagnosis in cases of equivocal or nondiagnostic ultrasounds. MRI also has been used to confirm an ultrasound diagnosis of adenomyosis when curative surgery is being considered. Intravenous gadolinium chelates are not necessary to make the diagnosis of either adenomyosis or leiomyomas, but it provides useful information about vascularity of lesions, a factor that may impact the type of treatment undertaken.

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Condition tags

endometriosisadenomyosis

MeSH descriptors

Endometriosis Leiomyoma Magnetic Resonance Imaging Magnetic Resonance Imaging Uterine Neoplasms Contrast Media Diagnosis, Differential Endometriosis Female Gadolinium Humans Image Enhancement Image Enhancement Leiomyoma Leiomyoma Practice Guidelines as Topic Sensitivity and Specificity Uterine Neoplasms Uterine Neoplasms

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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