Adenomyosis: MRI of the Uterus Treated with Uterine Artery Embolization
Reena C. Jha1,
Junko Takahama2,
Izumi Imaoka3,
Shahin J. Korangy1,
James B. Spies1,
Cirrelda Cooper1 and
Susan M. Ascher1
1 Department of Radiology, Georgetown University Medical Center, 3800 Reservoir
Rd. N.W., Washington, DC 20007.
2 Higashiosaka City General Hospital, 3-4-5 Nishiiwata, Higashiosaka, Osaka,
5788588 Japan..
3 Department of Radiology, MR Division, Tenri Hospital, 200 Mishima-cho, Tenri,
Nara 632-8552 Japan.
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Fig. 1. —Drawing shows classification of types of adenomyosis.
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Fig. 2A. —Asymmetric adenomyosis in 45-year-old woman. T2-weighted
image obtained before uterine artery embolization shows marked thickening of
anterior junctional zone (open arrow), with irregularity and mild
thickening of posterior junctional zone (solid arrow). Associated
fibroids are seen (asterisks).
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Fig. 2B. —Asymmetric adenomyosis in 45-year-old woman. T1-weighted
image obtained before treatment shows lobulated uterus. No
high-signal-intensity foci are seen.
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Fig. 2C. —Asymmetric adenomyosis in 45-year-old woman.
Contrast-enhanced T1-weighted image obtained before treatment shows poorly
defined areas of hypovascular enhancement in region of adenomyosis
(arrows). Conversely, fibroids show clear, well-defined margins
(asterisks).
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Fig. 2D. —Asymmetric adenomyosis in 45-year-old woman. T2-weighted
image obtained after uterine artery embolization shows confluent area of
decreased signal intensity (arrows) in anterior uterine body, with
loss of margins between adenomyosis and fibroid.
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Fig. 2E. —Asymmetric adenomyosis in 45-year-old woman. T1-weighted
image obtained after treatment shows large area of increased signal in this
region (arrows), typical of blood products.
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Fig. 2F. —Asymmetric adenomyosis in 45-year-old woman.
Contrast-enhanced T1-weighted image obtained after treatment shows no
significant enhancement in region of confluent adenomyosis and fibroid
(arrows).
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Fig. 3A. —51-year-old woman with symmetric pattern of adenomyosis.
T2-weighted sagittal image obtained before uterine artery embolization shows
florid adenomyosis involving anterior and posterior uterus (solid
arrows). Multiple punctate foci of high signal intensity are seen in
abnormal junctional zone (open arrows).
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Fig. 3B. —51-year-old woman with symmetric pattern of adenomyosis.
T1-weighted contrast-enhanced image obtained before treatment shows
heterogeneous pattern of enhancement in adenomyosis.
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Fig. 3C. —51-year-old woman with symmetric pattern of adenomyosis.
T2-weighted image obtained after uterine artery embolization shows greater
definition and homogeneity of junctional zone (arrows).
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Fig. 3D. —51-year-old woman with symmetric pattern of adenomyosis.
Contrast-enhanced T1-weighted image obtained after treatment shows no
appreciable enhancement throughout junctional zone.
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Fig. 4A. —48-year-old woman with uterine fibroids and coexisting
symmetric adenomyosis. T2-weighted HASTE sagittal image of uterus obtained
before uterine artery embolization shows uterine fibroids (asterisk)
and irregular thickening of junctional zone (straight arrows) along
anterior and posterior aspect of endometrium, representing symmetric
adenomyosis. Scattered foci of high signal intensity are also seen (curved
arrow).
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Fig. 4B. —48-year-old woman with uterine fibroids and coexisting
symmetric adenomyosis. Contrast-enhanced T1-weighted image obtained before
treatment shows fibroid (asterisk) and junctional zone
(arrows) as areas of decreased signal compared with outer
myometrium.
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Fig. 4C. —48-year-old woman with uterine fibroids and coexisting
symmetric adenomyosis. T2-weighted image obtained 3 months after treatment
shows decrease of dominant fibroid (asterisk), with no change in
junctional zone (arrows).
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Fig. 4D. —48-year-old woman with uterine fibroids and coexisting
symmetric adenomyosis. Contrast-enhanced T1-weighted image obtained after
treatment shows fibroids as regions of devascularization (asterisk),
whereas junctional zone vascularity is unchanged (arrows).
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Copyright © 2003 by the American Roentgen Ray Society.
