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Adenomyosis

Adenomyosis is a medical condition characterized by the presence of ectopic endometrial tissue (the inner lining of the uterus) within the myometrium (the thick, muscular layer of the uterus). more...

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The condition is typically found in women in the ages between 35 and 50. Patients with adenomyosis can have painful and/or profuse menses (dysmenorrhea & menorrhagia, respectively).

Adenomyosis may involve the uterus focally, creating an adenomyoma, or diffusely. With diffuse involvement, the uterus becomes bulky and heavier.

Causes

The cause of adenomyosis is unknown, although it has been associated with any sort of uterine trauma that may break the barrier between the endometrium and myometrium, such as Cesarean sections, tubal ligation, pregnancy termination, and any pregnancy.

Some say that the reason adenomyosis is common in women between the ages of 35 and 50 is because it is between these ages that women have an excess of estrogen. Near the age of 35, women typically cease to create as much natural progesterone, which counters the effects of estrogen. After the age of 50, due to menopause, women do not create as much estrogen.

Diagnosis

The uterus may be imaged using ultrasound (US) or magnetic resonance imaging (MR). Transvaginal ultrasound is the most cost effective and most available. Either modality will show an enlarged uterus. On ultrasound, the uterus will have a heterogeneous texture, without the focal well-defined masses that characterize uterine fibroids.

MR provides better diagnostic capability due to the increased spatial and contrast resolution, and to not being limited by the presence of bowel gas or calcified uterine fibroids (as is ultrasound). In particular, MR is better able to differentiate adenomyosis from multiple small uterine fibroids the uterus will have a thickened junctional zone with diminished signal on both T1 and T2 weighted sequences due to succeptibility effects of iron deposition due to chronic microhemorrhage. A thickness of the junctional zone greater than 10 or 12 mm (depending on who you read) is diagnostic of adenomyosis (<8 mm is normal). Interspersed within the thickened, hypointense signal of the junctional zone, one will often see foci of hyperintensity (brightness) on the T2 weighted scans representing small cystically dilatated glands or more acute sites of microhemorrhage.

MR can be used to classify adenomyosis based on the depth of penetration of the ectopic endometrium into the myometrium.

Treatment

Treatment options range from use of NSAIDS & hormonal suppression for symptomatic relief, to endometrial ablation or hysterectomy for a more or less permanent cure.

Those that believe an excess of estrogen is the cause or adenomyosis, or that it aggravates the symptoms, recommend avoiding products with xenoestrogens and/or recommend taking natural progesterone supplements.

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MRI adds value after transvaginal ultrasound diagnosis of adenomyosis: suspicious screen - Gynecology
From OB/GYN News, 2/15/04 by Patrice G.W. Norton

CHICAGO -- Magnetic resonance imaging offers valuable information following transvaginal ultrasound diagnosis of adenomyosis, Dr. Thomas Zacharia reported at the annual meeting of the Radiological Society of North America.

Recent studies have suggested that transvaginal ultrasound (TVUS) approaches pelvic MRI in sensitivity and specificity for the diagnosis of adenomyosis. A retrospective review found that MRI gave important added value after TVUS diagnosis of adenomyosis in 88% of subjects.

MRI provided supplementary diagnostic information in 44% of patients, provided a diagnostic alternative in 33% of patients, and otherwise called into question the TVUS diagnosis in 11% of patients.

"Ultrasound should continue as a screening tool, [but] MRI should follow if ultrasound is suspicious," said Dr. Zacharia, a research fellow at Harvard Medical School, Boston, where the study was conducted.

A total of 65 patients with adenomyosis suspicious on ultrasound underwent static pelvic MRI exams within 30 days of TVUS between Jan. 1, 2001, and Jan. 1, 2003. Eight patients were excluded from the study based on a lack of sonographic criteria. The 57 remaining subjects were aged 36-53 years, with a mean of 46 years.

TVUS was considered diagnostic for adenomyosis if at least three of the following six criteria were present: myometrial cysts, asymmetric myometrial thickening, enlarged uterus, globular shaped uterus, small echogenic myometrial nodules, and pain during ultrasound examination.

MRI confirmed the diagnosis of adenomyosis if any one of three criteria were present: junctional zone thickness greater than 12 mm, junctional zone cysts, or an indistinct junctional zone.

MRI confirmed adenomyosis in 32 (56%) of the 57 patients, but in 25 patients (44%) there was no MRI evidence of adenomyosis.

The findings at ultrasound were explained in 19 (33%) of the 57 patients by an alternative diagnosis of multiple small myometrial fibroids in 18 patients and a uterine arteriovenous malformation in 1 patient.

The remaining 6 patients (11%) had a normal-appearing uterus on MRI without any explanation of sonographic findings.

MRI did not reveal any additional adnexal findings not identified by TVUS.

While the MRI and TVUS diagnoses correlated in 32 patients, additional findings not suspected on TVUS were discovered in 25 of these patients (44% of the 57 subjects in the study).

Twenty patients were found to have myometrial fibroids in addition to adenomyosis, and 11 patients had unsuspected findings within the adnexae associated with endometriosis.

COPYRIGHT 2004 International Medical News Group
COPYRIGHT 2004 Gale Group

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