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TextAdenomyosis is a common, benign gynecologic disorder of premenopausal, multiparous women usually greater than 30 years old. It frequently co-exists with other pelvic diseases. It represents focal or diffuse invasion of the basal endometrium into the myometrium causing a reactive hyperplasia amidst small foci of entrapped glandular elements and hemorrhage. Basal endometria is not responsive to menstrual cycle hormonal fluctuations and thus the thickness of the endometrial layer does not vary with the menstrual cycle. The disease is sometimes referred to as “endometriosis interna”.

Women with adenomysis present with the nonspecific symptoms of menorrhagia and dysmenorrhea. The prevalence of the disease is 8.8 – 30% and is found in about 30% of hysterectomy specimens. Between 60 – 80% of patients have other pelvic disorders such as leiomyoma (35-55%) and endometriosis (36-40%).

Magnetic resonance imaging and transvaginal ultrasound are the best modalities with which to study adenomyosis. MRI has the advantage of better contrast resolution, larger field of view and superior sensitivity (88 – 93%) and specificity (66 – 91), but at a substantially greater financial cost. The MR image will show loss of the normal uterine junctional zone. It is instead expanded and replaced with focal or diffuse low T1 and T2 tissue signal, the thickness of which correlates well with the severity of adenomyosis. A junctional zone thickness of between 10 – 12 mm is a commonly accepted criterion for diagnosis. A requirement for greater thickness provides increased specificity. The low T2 signal is due to the proliferation of reactive smooth muscle elements in response to the endometrial invasion and a generally decreased vascularity of these areas. Linear striations of high T2 signal radiating from the endometrium are specific for adenomyosis. One may also see small foci of increased T2 signal. These are thought to represent small endometrial cysts, hemorrhage or endometrial tissue. This finding adds specificity to the imaging study.

Contrast enhanced sequences are not typically necessary. T1 weighted sequences may be helpful in identifying small hemorrhagic foci but otherwise add little to the study
References:Byun JY, Kim SE, Cho BO, et al. Diffuse and Focal Adenomyosis: MR Imaging Findings. Radiographics 1999. 19:S161-S170.

Jha RC, Takahama J, Imaoka I, et al. Adenomyosis: MRI of the Uterus Treated with Uterine Artery Embolization. AJR 2003, 181:851-856.

Reinhold C, Tafazoli F, Mehio A. Uterine Adenomyosis: Endovaginal US and MR Imaging Features with Histopathologic Correlation. Radiographics 1999: 19:514-516.

Siskin GP, Tublin ME, Stainken BF, et al. Uterine Artery Embolization for the Treatment of Adenomyosis: Clinical Response and Evaluation with MR Imaging. AJR 2001; 177:297-302.
ContributorKevin F. McCarthy (Civilian Medical Center)
Peer ReviewerAngela Levy, M.D. (Georgetown University Hospital)
Record Number : 5473
Created2004-02-06 06:03:52-05
Modified2004-06-10 01:28:21-04
Category:Neoplasm, benign
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