Abstract
Adenomyosis is a pathological gynaecological condition characterised by benign invasion of the endometrium into the myometrium. It is often misdiagnosed, or is not easily recognised, although it is responsible for disabling symptoms such as menorrhagia, abnormal uterine bleeding, dysmenorrhoea and infertility in premenopausal women. The aim of this pictorial review is to analyse the features of adenomyosis by illustrating the most usual and typical imaging patterns, along with the unusual appearances, seen in a vast array of gynaecological imaging modalities. The different findings of focal and diffuse adenomyosis along with the diagnostic limitations of ultrasound, hysterosalpingography and magnetic resonance imaging are described, as are the pitfalls and differential diagnosis with other pathological conditions that are often misdiagnosed as adenomyosis. The role of the different imaging modalities in planning appropriate treatment and their usefulness in monitoring therapy are also discussed.
Riassunto
L’adenomiosi è caratterizzata dall’invasione benigna del miometrio da parte dell’endometrio ed è spesso sottostimata o diagnosticata con ritardo, nonostante sia invalidante in quanto possibile causa di menorragia, metrorragia, dismenorrea ed infertilità. Lo scopo del lavoro è quello di analizzare gli aspetti diagnostici dell’adenomiosi mostrando i quadri più semplici e quelli più rari e difficili da caratterizzare, raccolti in una ampia galleria che prende in esame tutte le più note tecniche di imaging ginecologico. La forma diffusa di adenomiosi e quelle focali saranno analizzate sulla base dei segni di semeiotica elementare. I limiti e possibilità delle varie tecniche di imaging, ecografia, isterosalpingografia e risonanza magnetica, saranno illustrate ponendo anche particolare attenzione alla diagnostica differenziale con le altre forme morbose più facilmente equivocabili. Sarà infine discusso il ruolo delle metodiche di imaging nella pianificazione del tipo di trattamento e nel monitoraggio dell’efficacia terapeutica.
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References/Bibliografia
Bird CC, McElin TW, Manalo Estrella P (1972) The elusive adenomyosis of the uterus revisited. Am J Obstet Gynecol 112:583–593
Bergeron C, Amant F, Ferency A (2006) A pathology and physiopathology of adenomyosis. Best Pract Res Clin Obstet Gynaecol 20:511–521
Silverberg S, Kurman R (1992) Tumor-like lesions. In: Rosai J (ed) Tumor of the uterine corpus and gestational trophoblastic disease. Armed Forces Institute of Pathology, Washington DC, pp 210–212
Vercellini P, Viganò P, Somigliana E et al (2006) Adenomyosis: epidemiological factors. Best Pract Res Clin Obstet Gynaecol 20:465–477
Utsunomiya D, Notsute S, Hayashida Y et al (2004) Endometrial carcinoma in adenomyosis: assessment of myometrial invasion on T2-weighted spin-echo and gadolinium-enhanced T1-weighted images. AJR Am J Roentgenol 182:399–404
Peric H, Fraser IS (2006) The symptomatology of adenomyosis. Best Pract Res Clin Obstet Gynaecol 20:547–555
Pensa A, Favaro G (1970) Trattato di anatomia umana sistematica. Utet, Torino
Tamai K, Togashy K, Ito T et al (2005) MR imaging findings of adenomyosis: correlation with histopathologic features and diagnostic pitfalls. Radiographics 25:21–40
Wéry O, Thille A, Gaspard U et al (2005) Adenomyosis: update on a frequent but difficult diagnosis. J Gynecol Obstet Biol Reprod 34:633–648
Baker PM, Clement PB, Bell DA, Young RH (1999) Superficial endometriosis of the uterine cervix: a report of 20 cases of a process that may be confused with endocervical glandular dysplasia or adenocarcinoma in situ. Int J Gynecol Pathol 18:198–205
Dueholm M (2006) Transvaginal ultrasound for diagnosis of adenomyosis: a review. Best Pract Res Clin Obstet Gynaecol 20:569–682
Reinhold C, Tafazoli F, Mehio A et al (1999) Uterine adenomyosis: endovaginal US and MR imaging features with histopathologic correlation. Radiographics 19:S147–S160
Simpson WL, Beitia L, Mester J (2006) Hysterosalpingography: a re-emerging study. Radiographics 26:419–443
De Souza NM, Hawley IC, Schwieso JE et al (1994) The uterine cervix on in vitro and in vivo MR images: a study of zonal anatomy and vascularity using an enveloping cervical coil. AJR Am J Roentgenol 163:607–612
Faquhar C, Brosens I (2006) Medical and surgical management of adenomyosis. Best Pract Res Clin Obstet Gynaecol 20:603–616
Fedele L, Bianchi E, Raffaelli R et al (1997) Treatment of adenomyosis associated menorrhagia with levonorgestrel-releasing intrauterine device. Fertil Steril 68:426–429
Igarashi M, Abe Y, Fukuda M et al (2000) Novel conservative medical therapy for uterine adenomyosis with danazol-loaded intrauterine device. Fertil Steril 74:412–413
Furuhashy M, Miyabe M, Katsumata Y et al (1998) Comparison of complication of vaginal hysterectomy in patients with leiomyomas and in patients with adenomyosis. Arch Gynecol Obstet 262:69–73
Verma SK, Gonsalves CF, Baltarowich OH et al (2010) Spectrum of imaging findings on MRI and CT after uterine artery embolization. Abdom Imaging 35:118–128
Pelage JP, Jacob D, Fazel A et al (2005) Midterm results of uterine artery embolization for symptomatic adenomyosis: initial experience. Radiology 234:948–953
Siskin GP, Tublin ME, Stainken BF et al (2001) Uterine artery embolization for the treatment of adenomyosis clinical response and evaluation with MRI imaging. AJR Am J Roentgenol 177:297–302
Sanghi NT, Hawes RH (1994) High-intensity focused ultrasound. Gastrointest Endosc Clin N Am 4:383–395
Rabinovici J, Stewart EA (2006) New interventional techniques for adenomyosis. Best Pract Res Clin Obstet Gynaecol 20:617–636
Hyninen K, Freund WR, Cline HE et al (1996) A clinical non-invasive MR imaging-monitored ultrasound surgery method. Radiographics 16:185–195
Kinkel K, Frei KA, Balleyguier C, Chapron C (2006) Diagnosis of endometriosis with imaging: a review. Eur Radiol 16:285–298
Katayama M, Masui T, Kpbayashy S et al (2001) Evaluation of pelvic adhesions using multiphase and multislide MR imaging with kinematic display. AJR Am J Roentgenol 177:107–110
Manfredi R, Mirk P, Maresca G et al (2004) Local-regional staging of endometrial carcinoma: role of MR imaging in surgical planning. Radiology 231:372–378
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An erratum to this article can be found at http://dx.doi.org/10.1007/s11547-011-0726-1
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Valentini, A.L., Speca, S., Gui, B. et al. Adenomyosis: from the sign to the diagnosis. Imaging, diagnostic pitfalls and differential diagnosis: a pictorial review. Radiol med 116, 1267–1287 (2011). https://doi.org/10.1007/s11547-011-0714-5
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DOI: https://doi.org/10.1007/s11547-011-0714-5