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MR Imaging Findings of Adenomyosis: Correlation with Histopathologic Features and Diagnostic Pitfalls¹

¹ From the Department of Radiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan (K. Tamai, T.I., N.M.); the Departments of Nuclear Medicine and Diagnostic Imaging, Graduate School of Medicine, Kyoto University, Japan (K. Togashi, T.F.); and the Department of Radiology, Kyoto University Hospital, Japan (T.K.). Presented as an education exhibit at the 2003 RSNA Scientific Assembly. Received March 31, 2004; revision requested April 29 and received August 3; accepted August 5. All authors have no financial relationships to disclose. Address correspondence to K. Tamai, Departments of Nuclear Medicine and Diagnostic Imaging, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan (e-mail: tamai@kuhp.kyoto-u.ac.jp).

Adenomyosis is a nonneoplastic condition, characterized by benign invasion of ectopic endometrium into the myometrium with hyperplasia of adjacent smooth muscle. The common symptoms include dysmenorrhea, menorrhagia, and abnormal uterine bleeding, but these do not allow diagnosis. Therefore, imaging plays an important role because establishment of the correct preoperative diagnosis is critical to avoid unnecessary intervention. Magnetic resonance (MR) imaging is a highly accurate noninvasive modality for diagnosis of adenomyosis, differentiation of adenomyosis from other gynecologic disorders, and planning of appropriate treatment. Although the typical MR imaging findings are well established, adenomyosis actually varies widely in terms of histopathologic features (adenomyosis with sparse glands), growth patterns (polypoid adenomyoma, adenomyotic cyst, and miniature uterus), responses to hormonal activity (tamoxifen, decidual changes), and responses to treatment (gonadotropin-releasing hormone agonist). The MR imaging findings of adenomyosis occasionally mimic those of uterine malignancy or ovarian cancer. Furthermore, malignancy occasionally develops in otherwise benign adenomyosis. Pitfalls in diagnosis of adenomyosis include myometrial contractions, leiomyoma, adenomatoid tumor, metastases, endometrial carcinoma, and endometrial stromal sarcoma. Knowledge of the various appearances of adenomyosis and the possible pitfalls in differential diagnosis help guide the determination of appropriate treatment options.

© RSNA, 2005

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