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MRI of Adenomyosis: Changes with Uterine Artery Embolization

Yuri Kitamura1,2, Sandra J. Allison1, Reena C. Jha1, James B. Spies1, Pamela A. Flick1 and Susan M. Ascher1

1 Department of Radiology, Georgetown University Hospital, Lombardi Cancer Center, Washington, DC 20007.
2 Present address: Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunokicho Chuo-ku Kobe, Hyogo 650-0017, Japan.


Figure 1
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  		Fig. 1A —Measurements of uterine volume in 36-year-old woman. Uterine volume was calculated by obtaining sagittal (a, A), anteroposterior (b, A), and transverse (c, B) uterine dimensions in these T2-weighted sagittal (A) and T2-weighted axial (B) images and applying those dimensions to the formula for volume of a prolate ellipse.

 

Figure 2
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  		Fig. 1B —Measurements of uterine volume in 36-year-old woman. Uterine volume was calculated by obtaining sagittal (a, A), anteroposterior (b, A), and transverse (c, B) uterine dimensions in these T2-weighted sagittal (A) and T2-weighted axial (B) images and applying those dimensions to the formula for volume of a prolate ellipse.

 

Figure 3
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  		Fig. 2 —In this T2-weighted sagittal image of 47-year-old woman, junctional zone thickness was measured at its widest aspect (a). Myometrium was measured at same location (b) to calculate junctional zone-myometrial ratio (a / b).

 

Figure 4
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  		Fig. 3 —Distribution patterns of adenomyosis in 42-year-old woman. T2-weighted sagittal image of uterus shows diffuse widening of junctional zone, which is typical of symmetric pattern of adenomyosis.

 

Figure 5
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  		Fig. 4 —MR image shows asymmetric diffuse pattern in 44-year-old woman. Junctional zone is also diffusely widened with dominance to one side.

 

Figure 6
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  		Fig. 5 —MR image shows focal pattern in 51-year-old woman. Also known as adenomyoma, involved area is localized, poorly marginated, masslike lesion.

 

Figure 7
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  		Fig. 6 —Diagram shows MRI features approximately 6 months after uterine artery embolization. Numbers in parentheses show number of patients.

 

Figure 8
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  		Fig. 7A —44-year-old woman with asymmetric diffuse adenomyosis. T2-weighted axial (A) and T2-weighted sagittal (B) images (same patient as Fig. 4) obtained before uterine artery embolization (UAE) show asymmetric diffuse thickening of junctional zone with multiple high-signal-intensity foci within that zone, which is compatible with adenomyosis.

 

Figure 9
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  		Fig. 7B —44-year-old woman with asymmetric diffuse adenomyosis. T2-weighted axial (A) and T2-weighted sagittal (B) images (same patient as Fig. 4) obtained before uterine artery embolization (UAE) show asymmetric diffuse thickening of junctional zone with multiple high-signal-intensity foci within that zone, which is compatible with adenomyosis.

 

Figure 10
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  		Fig. 7C —44-year-old woman with asymmetric diffuse adenomyosis. Contrast-enhanced T1-weighted sagittal image obtained before UAE shows near-homogeneous enhancement in adenomyosis similar to adjacent myometrium. Note that high-signal-intensity foci do not enhance.

 

Figure 11
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  		Fig. 7D —44-year-old woman with asymmetric diffuse adenomyosis. T2-weighted sagittal image obtained 4 months after treatment shows decrease in uterine size and junctional zone thickness and new area of decreased signal intensity in region of adenomyosis.

 

Figure 12
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  		Fig. 7E —44-year-old woman with asymmetric diffuse adenomyosis. Contrast-enhanced T1-weighted sagittal image obtained during same study as D shows nonenhancement of this area, which signifies devascularization in region of adenomyosis.

 

Figure 13
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  		Fig. 8A —48-year-old woman with asymmetric diffuse adenomyosis. T2-weighted sagittal image obtained before uterine artery embolization (UAE) shows diffuse thickening of junctional zone dominant on posterior myometrium with focal areas of high signal intensity, which is compatible with adenomyosis.

 

Figure 14
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  		Fig. 8B —48-year-old woman with asymmetric diffuse adenomyosis. Contrast-enhanced T1-weighted sagittal image obtained before UAE shows homogeneous but delayed enhancement relative to myometrium in adenomyosis area.

 

Figure 15
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  		Fig. 8C —48-year-old woman with asymmetric diffuse adenomyosis. T2-weighted sagittal image obtained 4 months after UAE shows decrease in junctional zone thickness.

 

Figure 16
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  		Fig. 8D —48-year-old woman with asymmetric diffuse adenomyosis. Contrast-enhanced T1-weighted sagittal image obtained during same study as C shows continued near-homogeneous but less enhancement relative to myometrium with no apparent devascularization in area of adenomyosis.

 

Figure 17
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  		Fig. 9 —Diagram shows symptom questionnaire results completed by patients 3 months after uterine artery embolization (UAE). Numbers in parentheses show number of patients. NC = no change.

 

Figure 18
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  		Fig. 10 —Diagram shows symptom questionnaire results completed by patients 12 months after uterine artery embolization (UAE). Numbers in parentheses show number of patients. Asterisk indicates all 11 patients had also completed the symptom questionnaire 3 months after UAE. NC = no change.

 

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