MRT der uterinen Adenomyose bei infertilen Patientinnen: Ergebnisse und klinische Rückschlüsse

Subscribe to RSS DOI: 10.1055/s-2004-813644 © Georg Thieme Verlag KG Stuttgart · New York MRT der uterinen Adenomyose bei infertilen Patientinnen: Ergebnisse und klinische Rückschlüsse Uterine Adenomyosis in Infertile Patients: MR Imaging Findings and Clinical ConclusionsPublication History Publication Date: 20 October 2004 (online) Zusammenfassung Zielsetzung: Evaluierung der klinischen Wertigkeit der Magnetresonanztomographie (MRT) des Beckens bei infertilen Patientinnen mit symptomatischer Endometriose zur Beurteilung der Uterusmorphologie und -funktion. Material und Methode: 41 Patientinnen (mittleres Alter: 33,2 Jahre) mit laparoskopisch gesicherter symptomatischer Endometriose und unklarer Sterilität wurden mittels Hochfeld-MRT (Sonata, Siemens) unter Verwendung von T2- und T1-gewichteten Sequenzen untersucht. Zusätzlich wurde bei allen Patientinnen eine Hysterosalpingoszintigraphie (HSSG) zur Beurteilung der uterotubaren Transportkapazität durchgeführt. Die ermittelten Pathologien der uterinen Übergangszone (ÜZ) wurden mit den klinischen Symptomen und den laparoskopischen Ergebnissen sowie der uterotubaren Transportkapazität korreliert. Ergebnisse: In den T2-gewichteten MRT-Bildern zeigten sich bei 35 (85,4 %) Patientinnen Zeichen der Adenomyose (fokale Adenomyose bei 26 Patientinnen und diffuse Adenomyose bei 9 Patientinnen). Das mittlere Alter der Patientinnen mit Nachweis einer Adenomyose lag höher als bei den Frauen ohne Nachweis einer Adenomyose (34,1 vs. 30,1 Jahre). Mittels der HSSG konnte bei 73,1 % (19/26) der Patientinnen mit fokaler Adenomyose und bei 22,2 % (2/9) der Frauen mit diffuser Adenomyose ein regelhafter uterotubarer Transport beobachtet werden. Demgegenüber konnte bei 83,3 % (5/6) der Patientinnen ohne Adenomyose ein positiver Transport gefunden werden. Schlussfolgerung: Die MRT liefert wesentliche Zusatzinformationen zur Diagnostik des Uterus. Hierbei zeigen Patientinnen mit Adenomyose abhängig vom Ausprägungsgrad häufig eine reduzierte Spermientransportkapazität als möglichen Grund für eine Infertilität. Abstract Purpose: To evaluate the clinical value of magnetic resonance imaging (MRI) of the uterus and the pelvis in infertile female with symptomatic endometriosis for the assessment of uterine morphology and function. Materials and Methods: Forty-one infertile women (mean age: 33.2 years) with symptomatic endometriosis documented by laparoscopy were evaluated with high-field MRI (Sonata, Siemens) using T2- and T1-weighted sequences. In addition, the patients underwent hysterosalpingoscintigraphy (HSSG) for evaluation of the uterotubal transport capacity. Pathologic findings of the uterine junction zone were correlated with the laparoscopic results, clinical symptoms and uterotubal transport capacity. Results: Adenomyosis was diagnosed on T2-weigthed MR-images in 35 (85.4 %) patients (focal adenomatosis in 26 patients and diffuse adenomatosis in 9). Patients showing signs of adenomyosis tended to be older than patients without adenomyosis (mean age 34.1 years vs. 30.1 years) and showed a longer history of symptomatic endometriosis. A positive transport capacity in HSSG was observed in 73.1 % (19/26) of the patients with focal adenomyosis and in only 22.2 % (2/9) of patients with diffuse adenomyosis. In 83.3 % (5/6) of the patients without signs of adenomyosis, a positive uterotubal transport was documented. Conclusion: MRI of the uterus is a helpful diagnostic tool for the diagnosis of adenomyosis and for planning further therapies. Patients with the diagnosis of adenomyosis showed a reduced uterotubal transport capacity that depended on the severity of adenomyotic changes and might be a possible cause of infertility. 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