Adenomyosis

DENVER -- The presence of comorbid adenomyosis is no obstacle to successful uterine artery embolization for uterine fibroids, Dr. Reena C. Jha reported at the annual meeting of the International Society for Magnetic Resonance in Medicine.

Uterine artery embolization has become a popular therapy for symptomatic uterine fibroids, but the impact of uterine artery embolization on adenomyosis has not previously been studied.

Dr. Jha reported on the results of bilateral uterine artery embolization accomplished with the use of polyvinyl alcohol particles in 10 patients with both uterine fibroids and adenomyosis.

Their outcomes were similar to those of women treated only for uterine fibroids: a mean 35% reduction in uterine volume and a 42% decrease in the index fibroid volume.

Also, moderate to marked symptomatic improvement in bleeding was reported 3 months after the procedure by 8 of 10 affected patients. A similar degree of improvement in pain and pressure was reported by eight of nine affected women, said Dr. Jha, a radiologist at Georgetown University in Washington.

There was, however, no morphologic change in adenomyosis as assessed by MRI, she added.

The symptoms of uterine fibroids and adenomyosis overlap. Both conditions are very common. This small 10-patient series raises the possibility that the symptoms reported by patients with both disorders were due largely to their fibroids. Dr. Jha is now attempting to answer this question by conducting a study of uterine artery embolization in women with pure adenomyosis.

Adenomyosis is characterized by ectopic endometrial tissue surrounded by smooth muscle hyperplasia. It's a difficult clinical diagnosis to make because the presenting symptoms--pelvic pain, menorrhagia, and dysmenorrhea--are also prominent in leiomyoma, endometriosis, dysfunctional uterine bleeding, and other disorders.

In her keynote address opening the session on gynecologic and fetal MRI during which Dr. Jha presented her uterine artery ablation study, Dr. Caroline Reinhold asserted that endovaginal ultrasound is the initial imaging modality of choice in cases of suspected adenomyosis. It is more widely available and less costly than MRI. On the other hand, endovaginal ultrasound is also heavily operator dependent and therefore probably less accurate.

In various published series, the diagnostic accuracy of endovaginal ultrasound in adenomyosis has typically been reported to be 68%-86%, while MRI weighs in at 85%-90%.

MRI is usually reserved for patients with indeterminate endovaginal ultrasound findings, for preoperative evaluation, and for tracking the disease following conservative therapy said Dr. Reinhold, a radiologist at McGill University in Montreal.

The MRI criteria for diagnosis of adenomyosis focuses on the thickness of the junctional zone, a dark band of inner myometrium that normally has a 2- to 8-mm thickness. A junctional zone thickness has a very high positive predictive value for histopathologic adenomyosis. A thickness of 8-12 mm is indeterminate. A patient whose junctional zone is less than 8 mm probably doesn't have adenomyosis.

Secondary signs of adenomyosis on MRI include an irregular endomyometrial junction; an elliptical shape of the dark, low-signal abnormality; and the relative absence of a mass effect on the endometrium given the lesion size. Although differentiating nodular adenomyosis from leiomyoma can be a real diagnostic challenge, the leiomyoma tends to have better-defined borders and a mass effect.

It's important to differentiate suspected adenomyosis from other mimicking conditions because the treatments may vary considerably, she said.

COPYRIGHT 2000 International Medical News Group
COPYRIGHT 2001 Gale Group