Diffusion‐weighted imaging of uterine adenomyosis: Correlation with clinical backgrounds and comparison with malignant uterine tumors

Ryo Yajima, Yajima R, Aki Kido, Kido A, Yasuhisa Kurata, Kurata Y, Koji Fujimoto, Kyoko Kameyama Nakao, K. Nakao, Nakao KK, Kuwahara R, Ryo Kuwahara, Nishio N, Naoko Nishio, Minamiguchi S, Sachiko Minamiguchi, Masaki Mandai, Mandai M, Togashi K, Kaori Togashi
Journal of Obstetrics and Gynaecology Research · 2021 · vol. 47(3) , pp. 949–960 · doi:10.1111/jog.14621 · PMID:33511748 · W3124694016
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⚙ AI-generated summary by claude@2026-06, 2026-06-12 ⓘ

This study found that uterine adenomyosis exhibits varied diffusion-weighted imaging signal intensity correlated with menstrual cycle and can be distinguished from malignant uterine tumors by lower signal intensity and higher ADC values.

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Abstract

Abstract Aim To elucidate correlation between signal intensity on diffusion‐weighted images (SI‐DWI) and clinical backgrounds for uterine adenomyosis and to compare SI‐DWI of adenomyosis and malignant uterine tumors. Methods This study examined 46 adenomyosis patients diagnosed using magnetic resonance imaging and 25 patients with surgically confirmed malignant uterine myometrial tumor. First, adenomyosis cases were classified visually into high‐intensity and low‐intensity groups based on the SI‐DWI compared with that of normal uterine myometrium. Secondly, correlation was assessed between SI‐DWI of adenomyosis and patient clinical background information such as age, menopausal status, menstrual cycle and dysmenorrhea severity. Third, quantitative comparison was made of low‐intensity adenomyosis (LIA), high‐intensity adenomyosis (HIA) and malignant tumor groups for the signal intensity ratio (SIR) on DWI and the apparent diffusion coefficient (ADC). Their diagnostic performance was evaluated using logistic regression analysis and receiver operating characteristic (ROC) analysis. Results The 46 adenomyosis cases were classified as 26 low‐intensity and 20 high‐intensity cases. Significant correlation was found only for menstrual cycle phases. HIA had significantly lower SIR and higher ADC than malignant tumor. The ADC of HIA was significantly higher than that of LIA. The combination of SIR and ADC showed excellent diagnostic performance (area under ROC curve, 0.99). Conclusion There is a variation in signal intensity on DWI of uterine adenomyosis and it is associated with menstrual cycle phase. Adenomyosis with high signal intensity on DWI can be differentiated from malignant lesions by its lower signal intensity on DWI and higher ADC than that found for malignant uterine tumors, however overlaps exist.

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Condition tags

adenomyosisdysmenorrhea

MeSH descriptors

Adenomyosis Adenomyosis Uterine Neoplasms Uterine Neoplasms Diagnosis, Differential Diffusion Magnetic Resonance Imaging Female Humans Myometrium ROC Curve

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