Uterine adenomyosis with extensive glandular proliferation: case series of a rare imaging variant

Yudai Nakai, Eriko Maeda, Tomonori Kanda, Masako Ikemura, Tetsuo Ushiku, Yuko Sasajima, Saiko Isshiki, Osamu Abe
Diagnostic and interventional radiology (Ankara, Turkey) · 2020 · vol. 26(3) , pp. 153–159 · doi:10.5152/dir.2019.19252 · PMID:32209513 · PMC7239357 · W3010658968
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⚙ AI-generated summary by claude@2026-06, 2026-06-09 ⓘ

This case series identified a rare variant of uterine adenomyosis characterized by an extensive "fish-in-a-net" appearance on T2-weighted MRI, often associated with endometrial pathology and responding to hormonal therapy.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-10 · read from full text ⓘ

This retrospective case series studied the clinical and MRI features of uterine adenomyosis in six patients selected for an unusual T2-weighted appearance: an extensive high-signal-intensity myometrial area larger than the low-signal component, rather than the typical pattern. Across cases, MRI showed endometrial thickening with continuous spread of high signal into the myometrium, divided by low-signal “mesh” bands in a “fish-in-a-net” pattern, with diffusion restriction in 5/5 and gradual centripetal enhancement with delayed contrast defects in 4/4. Patients presented with vaginal bleeding and severe anemia; most received hormonal therapy, and in the 3 cases with follow-up imaging, the lesions decreased in size and evolved to resemble classical adenomyosis on MRI. Limitations include the small sample size, retrospective selection criteria, and variability in MRI protocols across institutions and scanners. This paper is centrally about adenomyosis — it defines a rare “fish-in-a-net” MRI variant and correlates it with clinical presentation and treatment-related imaging changes in uterine adenomyosis.

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Abstract

PURPOSE: We aimed to investigate the clinical and magnetic resonance imaging (MRI) characteristics of uterine adenomyosis, in which there is an extensive area of high signal intensity in the myometrium on T2-weighted MRI. METHODS: This retrospective radiographic study reviewed a case series of six patients (mean age, 36 years) with adenomyosis. These patients were selected because, unlike in classical adenomyosis, T2-weighted images showed a larger area of high signal intensity than that of low signal intensity in the myometrium. The morphology of the myometrial lesions, patterns of contrast enhancement (n=4), intramyometrial hemorrhaging, diffusion restriction (n=5), endometrial lesions, and imaging findings after treatment (n=3) were evaluated on MRI. RESULTS: The patients' clinical symptoms included vaginal bleeding and severe anemia. Four were administered hormonal therapy, one underwent hysterectomy, and one underwent enucleation. On T2-weighted images, all showed endometrial thickening and a high signal intensity area in the myometrium that was divided up by a mesh of low signal intensity bands, with an appearance reminiscent of a fish caught in a net. Other findings included gradual centripetal enhancement with contrast defects in multicystic areas (4/4), an intramyometrial hemorrhage (1/6), and increased diffusion (5/5). Following hormonal therapy, the uteruses decreased in size and were similar to those of classical adenomyosis on MRI (3/3). The lesions were diagnosed as adenomyosis with a proliferation of adenomyotic glandular tissue and a proliferative endometrial polyp. CONCLUSION: This case series suggests that there is a subgroup of uterine adenomyosis that shows a characteristic "fish-in-a-net" appearance on T2-weighted images.
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Abstract

PURPOSE We aimed to investigate the clinical and magnetic resonance imaging (MRI) characteristics of uterine adenomyosis, in which there is an extensive area of high signal intensity in the myometrium on T2-weighted MRI.

Methods

This retrospective radiographic study reviewed a case series of six patients (mean age, 36 years) with adenomyosis. These patients were selected because, unlike in classical adenomyosis, T2-weighted images showed a larger area of high signal intensity than that of low signal intensity in the myometrium. The morphology of the myometrial lesions, patterns of contrast enhancement (n=4), intramyometrial hemorrhaging, diffusion restriction (n=5), endometrial lesions, and imaging findings after treatment (n=3) were evaluated on MRI.

Results

The patients’ clinical symptoms included vaginal bleeding and severe anemia. Four were administered hormonal therapy, one underwent hysterectomy, and one underwent enucleation. On T2-weighted images, all showed endometrial thickening and a high signal intensity area in the myometrium that was divided up by a mesh of low signal intensity bands, with an appearance reminiscent of a fish caught in a net. Other findings included gradual centripetal enhancement with contrast defects in multicystic areas (4/4), an intramyometrial hemorrhage (1/6), and increased diffusion (5/5). Following hormonal therapy, the uteruses decreased in size and were similar to those of classical adenomyosis on MRI (3/3). The lesions were diagnosed as adenomyosis with a proliferation of adenomyotic glandular tissue and a proliferative endometrial polyp.

Conclusion

This case series suggests that there is a subgroup of uterine adenomyosis that shows a characteristic “fish-in-a-net” appearance on T2-weighted images.

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Condition tags

adenomyosis

MeSH descriptors

Adenomyosis Magnetic Resonance Imaging Uterine Neoplasms Uterus Adenomyosis Adenomyosis Adenomyosis Adult Anemia Anemia Anemia Cell Proliferation Female Hormones Hormones Hormones Humans Hysterectomy Hysterectomy Magnetic Resonance Imaging

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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