Phenotypic characterization of adenomyosis occurring at the inner and outer myometrium - Fig 1

Yohei Kishi (523863), Keiji Shimada (3536696), Tomomi Fujii (522186), Tomoko Uchiyama (4691596), Chiharu Yoshimoto (4691599), Noboru Konishi (513254), Chiho Ohbayashi (4691593), Hiroshi Kobayashi (23858)
2017 · doi:10.1371/journal.pone.0189522.g001 · W6961058147
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This study utilizes T2-weighted magnetic resonance imaging to characterize two distinct subtypes of adenomyosis based on their location within the myometrium. Subtype I involves adenomyotic foci at the inner myometrium with a direct connection to the junctional zone, typically observed in multiparous women. In contrast, Subtype II presents in the outer myometrium without affecting the junctional zone and is associated with utero-rectal adhesions suggestive of pelvic endometriosis. This paper is centrally about adenomyosis — specifically distinguishing between inner and outer myometrial phenotypes via MRI findings.

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Abstract

(a) Subtype I adenomyosis. T2-weighted magnetic resonance image (sagittal section) of a uterus with Subtype I adenomyosis. The endometrium (EM) is seen as a T2 high intensity band at the inner most part of the uterus. Adenomyosis resides at the inner myometrium with a direct connection to the junctional zone (JZ). The JZ is a T2 low intensity band surrounding the endometrium (arrows). Adenomyotic foci are seen as a T2 low intensity areas with small high intensity spots in the myometrium. The border between the adenomyotic foci and the outer myometrium are indicated by arrow heads. The outer myometrium is preserved and intact. This image was taken for a 39-year old multiparous woman. (b) Subtype II adenomyosis. T2-weighted magnetic resonance image (sagittal section) of a uterus with Subtype II adenomyosis. Adenomyosis resides in the posterior outer myometrium without affecting the JZ (arrows). The border between the adenomyotic foci and the surrounding myometrium is indicated by arrows. The healthy muscle structures are seen in between the adenomyosis and the JZ. Utero-rectal adhesion caused by pelvic endometriosis is suspected. This image was taken for a 30-year old nulliparous woman.
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Phenotypic characterization of adenomyosis occurring at the inner and outer myometrium Fig 1 (a) Subtype I adenomyosis. T2-weighted magnetic resonance image (sagittal section) of a uterus with Subtype I adenomyosis. The endometrium (EM) is seen as a T2 high intensity band at the inner most part of the uterus. Adenomyosis resides at the inner myometrium with a direct connection to the junctional zone (JZ). The JZ is a T2 low intensity band surrounding the endometrium (arrows). Adenomyotic foci are seen as a T2 low intensity areas with small high intensity spots in the myometrium. The border between the adenomyotic foci and the outer myometrium are indicated by arrow heads. The outer myometrium is preserved and intact. This image was taken for a 39-year old multiparous woman. (b) Subtype II adenomyosis. T2-weighted magnetic resonance image (sagittal section) of a uterus with Subtype II adenomyosis. Adenomyosis resides in the posterior outer myometrium without affecting the JZ (arrows). The border between the adenomyotic foci and the surrounding myometrium is indicated by arrows. The healthy muscle structures are seen in between the adenomyosis and the JZ. Utero-rectal adhesion caused by pelvic endometriosis is suspected. This image was taken for a 30-year old nulliparous woman.

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