Adenomyosis of Uterus

ADENOMYOSIS of the UTERUS

Adenomyosis is the presence of ectopic endometrial glands and stroma embedded within the myometrium. Morphologically adenomyosis is classified into two : Focal and Diffuse. Clinicians and pathologist distinguishes between Superficial and Deep adenomysosis.

Adenomyotic endometrial glands do not typically undergo cyclical bleeding. In cases where there is extensive hemorrhages within the ectopic endometrial tissue, results in cystic adenomyosis.

Adenomyosis is a relatively common gynecologic disorder, with incidences up to 20% to 60%, seen in reproductive and perimenopausal ages. Common symptoms include dysmenorrhoea and menorrhagia.

DIAGNOSIS by MRI relies mainly on the T2 Weighted Images which depict the zonal anatomy. Thickened junctional zone >12mm is usually considered as diagnostic of Adenomyosis.

(T2 Sagittal Image showing thickened junctional zone, measuring up to 14.2mm, T1 hyperintense focus secondary to hemorrhage)

Ancilliary findings include Poorly defined margins, High signal intensity focus on T1 and T2 images and Linear high signal striations radiating from endometrial surface.

In some cases there may be T1 hyperintense foci which corresponds to the areas of hemorrhage within the ectopic endometrial tissue (see image above).

References
1. Clinical MRI - Edelman.