27. ULTRASOUND CHARACTERISTICS OF ADENOMYOSIS. ill defined hypoechoic areas hetrogeneous myometrial echotexture small anechioc lakes asymetrical uterine enlargement indistinct endometrial-myometrial border subendometrial halo thickening
28. areas of decreased signal intensity at (MR bright foci are seen On T2-weighted MR within the myometrium characterized by the presence of heterotopic endometrial glands and stroma in the myometrium corresponds to areas of decreased echogenicity on TVS with small echogenic islands on TVS The ratio of heterotopic endometrial tissue to smooth muscle decreased echogenicity partly determines the imaging appearance adjacent smooth muscle hyperplasia. histopathologic ultrasonographic ,MRI correlation
29. normal myometrium ( M ), homogeneous echotexture The subendometrial haloas a thin hypoechoic band (arrows). The endometrium is uniformly echogenic NORMAL
30. E = endometrium myometrium is thickened ventrally and has a heterogeneous echotexture myometrial cyst (curved arrow). The echogenicity of the ventral myometrium is decreased relative to that of the dorsal myometrium decreased uterine echogenicity without lobulations, contour abnormality, or mass effects, excentric endometrial cavity Adenomyosis
31. ULTRASOUND CHARACTERISTICS OF ADENOMYOSIS. uterine dimensions Symmetry of myometrium echogenicity of the myometrium Brosens and co-workers assessed ultrasonographic details such as: They found that The most predictive is the ill-defined heterogeneous echotexture within the myometrium.
32. Accuracy of endovaginal ultrasonography in the diagnosis of diffuse adenomyosis. 20 90 50 86 17/20 (85) Asher et al. (1994) 77 86 75 53 28/56 (50) Brosens et al. (1995) 94 71 86 29/100 (29) Reinhold et al. (1995) 98 68.4 96.2 86 15/175 (86) Atzori et al. (1996) 96 71 89 89 18/119 (24) Reinhold et al. (1996) NPV% PPV% Specificity% Sensitivity% Prevalence % 86
39. 20 women with clinically suspected adenomyosis underwent MR imaging and transvaginal Sonography Pathologic proof was obtained in all cases. 8/17 1/17 9/17 TVUS 1/17 1/17 15/17 MRI False -ve False +ve Correct diag. 17 patients were proved to have adenomyosis. Department of Radiology, Georgetown University Medical Center,
41. studied 106 consecutive premenopausal women who underwent hysterectomy for benign reasons. Transvaginal ultrasonography and MRI were compared with histopathologic examination as the golden standard 22 (21%) patients had adenomyosis. Department of Gynecology and Obstetrics, Aarhus University and Aarhus University Hospital, Aarhus, Denmark 60 89 COMBINED 65 68 TVUS 86 70 MRI specificity sensitivity
42.
43.
44. Sagittal T1-weighted MR image shows a mildly enlarged anteverted uterus. The junctional zone is isointense relative to the myometrium.
45. Sagittal T2-weighted MR image shows diffuse, even thickening of the junctional zone (arrows), a finding consistent with diffuse adenomyosis
46. Extensive involvement of diffuse adenomyosis in a 42-year-old woman. Sagittal T2-weighted MR image demonstrates diffuse areas of low signal intensity involving most of the uterus (straight arrows) and punctate high-signal-intensity foci (arrowhead). A few small nabothian cysts (curved arrows) are seen in the uterine cervix.
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