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MR Imaging of Disorders Associated with Female Infertility: Use in Diagnosis, Treatment, and Management¹

¹ From the Departments of Radiology (I.I., A.W., M.M.) and Obstetrics and Gynecology (M.Y.), Tenri Hospital, 200 Mishima, Tenri, Nara 632-8552, Japan; the Department of Radiology, Shimane Medical University, Izumo, Japan (H.K.); and the Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan (K.S.). Presented as an education exhibit at the 2001 RSNA scientific assembly. Received July 1, 2002; revision requested August 22; final revision received May 9, 2003; accepted May 12. Address correspondence to I.I. (e-mail: iizumi@tenriyorozu-hp.or.jp).

View larger version (177K): [in a new window]   Figure 1.  Normal uterus in a woman of reproductive age. Sagittal T2-weighted image of the uterus shows the endometrium (E), junctional zone (short arrows), and myometrium (M). It also shows the epithelium (arrowhead), fibrous stroma (long arrow), and peripheral myometrium (m) of the cervix.

View larger version (175K): [in a new window]   Figure 2.  Postmenopausal uterus. Sagittal T2-weighted image shows a small uterine corpus that is almost the same size as the cervix (arrows). The zonal anatomy of the corpus is indistinct.

View larger version (162K): [in a new window]   Figure 3.  Atrophic uterus in a 23-year-old woman with amenorrhea. She had been treated with carcinostatic agents for a brain tumor, and there was clinical suspicion that those medications caused ovarian failure and concomitant uterine atrophy. Sagittal T2-weighted image shows a small uterus, a finding suggestive of insufficient hormone secretion in a reproductive-age woman. Arrow = nabothian cyst. (Reprinted, with permission, from reference 50.)

View larger version (132K): [in a new window]   Figure 4a.  Pituitary microadenoma. (a) Coronal T1-weighted image shows a pituitary gland that is not enlarged. (b) Coronal T1-weighted image obtained after intravenous bolus injection of contrast material shows a mass with decreased enhancement (arrow) in the pituitary gland.

View larger version (121K): [in a new window]   Figure 4b.  Pituitary microadenoma. (a) Coronal T1-weighted image shows a pituitary gland that is not enlarged. (b) Coronal T1-weighted image obtained after intravenous bolus injection of contrast material shows a mass with decreased enhancement (arrow) in the pituitary gland.

View larger version (158K): [in a new window]   Figure 5a.  Pituitary macroadenoma. Coronal unenhanced (a) and contrast-enhanced (b) T1-weighted images show a macroadenoma (arrowheads), which occupies the pituitary fossa and invades the left cavernous sinus (arrow).

View larger version (169K): [in a new window]   Figure 5b.  Pituitary macroadenoma. Coronal unenhanced (a) and contrast-enhanced (b) T1-weighted images show a macroadenoma (arrowheads), which occupies the pituitary fossa and invades the left cavernous sinus (arrow).

View larger version (150K): [in a new window]   Figure 6.  Polycystic ovarian syndrome. Axial T2-weighted image shows multiple tiny, hyperintense peripheral cysts (arrows) in the left ovary. The central stroma appears as a hypointense area (arrowhead). U = uterus. (Reprinted, with permission, from reference 50.)

View larger version (148K): [in a new window]   Figure 7a.  Hydrosalpinx. Axial T2-weighted (a) and contrast-enhanced fat-suppressed T1-weighted (b) images show a cystic mass of the left adnexa (arrow). The mass has a folded (arrowheads) and tortuous appearance. Therefore, it was diagnosed as a fluid-filled dilated fallopian tube.

View larger version (125K): [in a new window]   Figure 7b.  Hydrosalpinx. Axial T2-weighted (a) and contrast-enhanced fat-suppressed T1-weighted (b) images show a cystic mass of the left adnexa (arrow). The mass has a folded (arrowheads) and tortuous appearance. Therefore, it was diagnosed as a fluid-filled dilated fallopian tube.

View larger version (137K): [in a new window]   Figure 8a.  Tubo-ovarian abscess. Axial T2-weighted (a) and contrast-enhanced fat-suppressed T1-weighted (b) images show a tortuous mass of the right adnexa. The mass consists of an ovarian abscess (short arrow) and hydrosalpinx (arrowheads), which demonstrate marked perilesion enhancement. Adenomyosis is incidentally seen in the posterior myometrium (long arrow).

View larger version (132K): [in a new window]   Figure 8b.  Tubo-ovarian abscess. Axial T2-weighted (a) and contrast-enhanced fat-suppressed T1-weighted (b) images show a tortuous mass of the right adnexa. The mass consists of an ovarian abscess (short arrow) and hydrosalpinx (arrowheads), which demonstrate marked perilesion enhancement. Adenomyosis is incidentally seen in the posterior myometrium (long arrow).

View larger version (170K): [in a new window]   Figure 9a.  Hematosalpinx associated with endometriosis. Sagittal fat-suppressed T1-weighted (a) and T2-weighted (b) images show a dilated fallopian tube with a folded appearance (arrow). It has high signal intensity on both images and was diagnosed as a hematosalpinx. On the fat-suppressed T1-weighted image (a), a small endometrioma is seen as a tiny hyperintense lesion (arrowhead) on the surface of the hematosalpinx. B = bladder. (Reprinted, with permission, from reference 50.)

View larger version (201K): [in a new window]   Figure 9b.  Hematosalpinx associated with endometriosis. Sagittal fat-suppressed T1-weighted (a) and T2-weighted (b) images show a dilated fallopian tube with a folded appearance (arrow). It has high signal intensity on both images and was diagnosed as a hematosalpinx. On the fat-suppressed T1-weighted image (a), a small endometrioma is seen as a tiny hyperintense lesion (arrowhead) on the surface of the hematosalpinx. B = bladder. (Reprinted, with permission, from reference 50.)

View larger version (37K): [in a new window]   Figure 10.  American Fertility Society classification of müllerian duct anomalies. DES = diethylstilbestrol, * = uterus may be normal or take a variety of abnormal forms, ** = may have two distinct cervices. (Reprinted, with permission, from reference 17.)

View larger version (205K): [in a new window]   Figure 11a.  Mayer-Rokitansky-Küster-Hauser syndrome in a woman with primary amenorrhea. B = bladder. (a) Sagittal T2-weighted image shows uterine agenesis and absence of the vagina. (b) Coronal image obtained with true fast imaging with steady-state precession shows agenesis of the left kidney. Note the normal right ovary with follicles (arrow). Arrowheads = right kidney.

View larger version (209K): [in a new window]   Figure 11b.  Mayer-Rokitansky-Küster-Hauser syndrome in a woman with primary amenorrhea. B = bladder. (a) Sagittal T2-weighted image shows uterine agenesis and absence of the vagina. (b) Coronal image obtained with true fast imaging with steady-state precession shows agenesis of the left kidney. Note the normal right ovary with follicles (arrow). Arrowheads = right kidney.

View larger version (131K): [in a new window]   Figure 12a.  Unicornuate uterus. Serial axial T2-weighted images (a obtained at a higher level than b) show a small uterus (arrow) with normal zonal anatomy. A rudimentary horn is not present. Arrowhead = right ovary.

View larger version (129K): [in a new window]   Figure 12b.  Unicornuate uterus. Serial axial T2-weighted images (a obtained at a higher level than b) show a small uterus (arrow) with normal zonal anatomy. A rudimentary horn is not present. Arrowhead = right ovary.

View larger version (151K): [in a new window]   Figure 13a.  Uterus didelphys with an obstructed hemivagina. (a) Axial T2-weighted image shows two separate uteri and two cervices (arrows), all of which have normal zonal anatomy. Arrowheads = ovaries. (b) Coronal T2-weighted image shows a hematocele (H) due to obstruction of the right hemivagina. (c) Contrast-enhanced computed tomographic (CT) scan shows agenesis of the right kidney. Uterus didelphys with an obstructed hemivagina is termed Wunderlich syndrome and is usually associated with ipsilateral renal agenesis. (Reprinted, with permission, from reference 50.)

View larger version (177K): [in a new window]   Figure 13b.  Uterus didelphys with an obstructed hemivagina. (a) Axial T2-weighted image shows two separate uteri and two cervices (arrows), all of which have normal zonal anatomy. Arrowheads = ovaries. (b) Coronal T2-weighted image shows a hematocele (H) due to obstruction of the right hemivagina. (c) Contrast-enhanced computed tomographic (CT) scan shows agenesis of the right kidney. Uterus didelphys with an obstructed hemivagina is termed Wunderlich syndrome and is usually associated with ipsilateral renal agenesis. (Reprinted, with permission, from reference 50.)

View larger version (100K): [in a new window]   Figure 13c.  Uterus didelphys with an obstructed hemivagina. (a) Axial T2-weighted image shows two separate uteri and two cervices (arrows), all of which have normal zonal anatomy. Arrowheads = ovaries. (b) Coronal T2-weighted image shows a hematocele (H) due to obstruction of the right hemivagina. (c) Contrast-enhanced computed tomographic (CT) scan shows agenesis of the right kidney. Uterus didelphys with an obstructed hemivagina is termed Wunderlich syndrome and is usually associated with ipsilateral renal agenesis. (Reprinted, with permission, from reference 50.)

View larger version (152K): [in a new window]   Figure 14.  Bicornuate uterus. Axial T2-weighted image shows two endometrial cavities and one cervix. The external uterine contour is concave (short arrow) with a large intercornual distance (arrowheads). Long arrows = nabothian cysts.

View larger version (160K): [in a new window]   Figure 15.  Septate uterus. Axial T2-weighted image shows a normal external uterine contour (arrowheads). A thin fibrous septum is seen in the uterine cavity (arrow). (Reprinted, with permission, from reference 50.)

View larger version (176K): [in a new window]   Figure 16.  Adenomyosis. Sagittal T2-weighted image shows an enlarged uterus. An ill-defined myometrial lesion of decreased signal intensity is seen in the fundus, along with multiple small hyperintense foci (arrowheads). Arrows = nabothian cysts.

View larger version (171K): [in a new window]   Figure 17a.  Adenomyosis treated with GnRH analog. (a) Sagittal T2-weighted image obtained before treatment shows adenomyosis in the posterior myometrium (arrows) with punctate hyperintense foci. (b) Sagittal T2-weighted image obtained after GnRH analog therapy shows that the lesion (arrows) is significantly smaller. The interface between the lesion and the myometrium is more discrete. (c) Sagittal T2-weighted image obtained 1 year after the end of treatment shows that the lesion (arrows) has returned to its pretherapy appearance.

View larger version (175K): [in a new window]   Figure 17b.  Adenomyosis treated with GnRH analog. (a) Sagittal T2-weighted image obtained before treatment shows adenomyosis in the posterior myometrium (arrows) with punctate hyperintense foci. (b) Sagittal T2-weighted image obtained after GnRH analog therapy shows that the lesion (arrows) is significantly smaller. The interface between the lesion and the myometrium is more discrete. (c) Sagittal T2-weighted image obtained 1 year after the end of treatment shows that the lesion (arrows) has returned to its pretherapy appearance.

View larger version (180K): [in a new window]   Figure 17c.  Adenomyosis treated with GnRH analog. (a) Sagittal T2-weighted image obtained before treatment shows adenomyosis in the posterior myometrium (arrows) with punctate hyperintense foci. (b) Sagittal T2-weighted image obtained after GnRH analog therapy shows that the lesion (arrows) is significantly smaller. The interface between the lesion and the myometrium is more discrete. (c) Sagittal T2-weighted image obtained 1 year after the end of treatment shows that the lesion (arrows) has returned to its pretherapy appearance.

View larger version (190K): [in a new window]   Figure 18.  Uterine leiomyomas. Sagittal T2-weighted image shows multiple uterine leiomyomas, including lesions with submucosal (M) and intramural (m) locations. Leiomyomas usually appear as sharply marginated hypointense masses on T2-weighted images, in contrast to adenomyosis (cf Fig 16). Arrows = nabothian cysts.

View larger version (178K): [in a new window]   Figure 19a.  Uterine leiomyoma treated with myomectomy. (a) Sagittal T2-weighted image obtained before myomectomy shows a submucosal leiomyoma (arrow) in the anterior wall of the uterus. (b) Sagittal T2-weighted image obtained 6 months after myomectomy shows that the thickness of the myometrium has become normal. The transverse postoperative scar is seen as a low-signal-intensity line in the anterior myometrium (arrowhead).

View larger version (179K): [in a new window]   Figure 19b.  Uterine leiomyoma treated with myomectomy. (a) Sagittal T2-weighted image obtained before myomectomy shows a submucosal leiomyoma (arrow) in the anterior wall of the uterus. (b) Sagittal T2-weighted image obtained 6 months after myomectomy shows that the thickness of the myometrium has become normal. The transverse postoperative scar is seen as a low-signal-intensity line in the anterior myometrium (arrowhead).

View larger version (149K): [in a new window]   Figure 20a.  Uterine leiomyomas treated with UAE. (a-c) Sagittal T1-weighted (a), T2-weighted half-Fourier single-shot turbo spin-echo (b), and contrast-enhanced T1-weighted (c) images obtained before UAE show three uterine leiomyomas (arrows in b and c). (d-f) Corresponding images obtained 3 months after UAE show changes in the signal intensity of the leiomyomas. (d) T1-weighted image shows that the leiomyomas (arrows) now have high signal intensity. White circles = regions of interest for signal intensity measurement. (e) T2-weighted half-Fourier single-shot turbo spin-echo image shows a more discrete interface between the leiomyomas (arrows) and the myometrium. (f) Contrast-enhanced T1-weighted image shows significantly diminished vascularity in all three leiomyomas (arrows). Note that myometrial enhancement is maintained. (Case courtesy of Susan M. Ascher, MD, Georgetown University Hospital, Washington, DC.)

View larger version (161K): [in a new window]   Figure 20b.  Uterine leiomyomas treated with UAE. (a-c) Sagittal T1-weighted (a), T2-weighted half-Fourier single-shot turbo spin-echo (b), and contrast-enhanced T1-weighted (c) images obtained before UAE show three uterine leiomyomas (arrows in b and c). (d-f) Corresponding images obtained 3 months after UAE show changes in the signal intensity of the leiomyomas. (d) T1-weighted image shows that the leiomyomas (arrows) now have high signal intensity. White circles = regions of interest for signal intensity measurement. (e) T2-weighted half-Fourier single-shot turbo spin-echo image shows a more discrete interface between the leiomyomas (arrows) and the myometrium. (f) Contrast-enhanced T1-weighted image shows significantly diminished vascularity in all three leiomyomas (arrows). Note that myometrial enhancement is maintained. (Case courtesy of Susan M. Ascher, MD, Georgetown University Hospital, Washington, DC.)

View larger version (154K): [in a new window]   Figure 20c.  Uterine leiomyomas treated with UAE. (a-c) Sagittal T1-weighted (a), T2-weighted half-Fourier single-shot turbo spin-echo (b), and contrast-enhanced T1-weighted (c) images obtained before UAE show three uterine leiomyomas (arrows in b and c). (d-f) Corresponding images obtained 3 months after UAE show changes in the signal intensity of the leiomyomas. (d) T1-weighted image shows that the leiomyomas (arrows) now have high signal intensity. White circles = regions of interest for signal intensity measurement. (e) T2-weighted half-Fourier single-shot turbo spin-echo image shows a more discrete interface between the leiomyomas (arrows) and the myometrium. (f) Contrast-enhanced T1-weighted image shows significantly diminished vascularity in all three leiomyomas (arrows). Note that myometrial enhancement is maintained. (Case courtesy of Susan M. Ascher, MD, Georgetown University Hospital, Washington, DC.)

View larger version (159K): [in a new window]   Figure 20d.  Uterine leiomyomas treated with UAE. (a-c) Sagittal T1-weighted (a), T2-weighted half-Fourier single-shot turbo spin-echo (b), and contrast-enhanced T1-weighted (c) images obtained before UAE show three uterine leiomyomas (arrows in b and c). (d-f) Corresponding images obtained 3 months after UAE show changes in the signal intensity of the leiomyomas. (d) T1-weighted image shows that the leiomyomas (arrows) now have high signal intensity. White circles = regions of interest for signal intensity measurement. (e) T2-weighted half-Fourier single-shot turbo spin-echo image shows a more discrete interface between the leiomyomas (arrows) and the myometrium. (f) Contrast-enhanced T1-weighted image shows significantly diminished vascularity in all three leiomyomas (arrows). Note that myometrial enhancement is maintained. (Case courtesy of Susan M. Ascher, MD, Georgetown University Hospital, Washington, DC.)

View larger version (162K): [in a new window]   Figure 20e.  Uterine leiomyomas treated with UAE. (a-c) Sagittal T1-weighted (a), T2-weighted half-Fourier single-shot turbo spin-echo (b), and contrast-enhanced T1-weighted (c) images obtained before UAE show three uterine leiomyomas (arrows in b and c). (d-f) Corresponding images obtained 3 months after UAE show changes in the signal intensity of the leiomyomas. (d) T1-weighted image shows that the leiomyomas (arrows) now have high signal intensity. White circles = regions of interest for signal intensity measurement. (e) T2-weighted half-Fourier single-shot turbo spin-echo image shows a more discrete interface between the leiomyomas (arrows) and the myometrium. (f) Contrast-enhanced T1-weighted image shows significantly diminished vascularity in all three leiomyomas (arrows). Note that myometrial enhancement is maintained. (Case courtesy of Susan M. Ascher, MD, Georgetown University Hospital, Washington, DC.)

View larger version (160K): [in a new window]   Figure 20f.  Uterine leiomyomas treated with UAE. (a-c) Sagittal T1-weighted (a), T2-weighted half-Fourier single-shot turbo spin-echo (b), and contrast-enhanced T1-weighted (c) images obtained before UAE show three uterine leiomyomas (arrows in b and c). (d-f) Corresponding images obtained 3 months after UAE show changes in the signal intensity of the leiomyomas. (d) T1-weighted image shows that the leiomyomas (arrows) now have high signal intensity. White circles = regions of interest for signal intensity measurement. (e) T2-weighted half-Fourier single-shot turbo spin-echo image shows a more discrete interface between the leiomyomas (arrows) and the myometrium. (f) Contrast-enhanced T1-weighted image shows significantly diminished vascularity in all three leiomyomas (arrows). Note that myometrial enhancement is maintained. (Case courtesy of Susan M. Ascher, MD, Georgetown University Hospital, Washington, DC.)

View larger version (170K): [in a new window]   Figure 21a.  Uterine leiomyomas treated with UAE. Sagittal T2-weighted half-Fourier single-shot turbo spin-echo images obtained before UAE (a) and 3 months after UAE (b) show multiple uterine leiomyomas. Both the uterus and the leiomyomas are smaller after UAE (b). The submucosal lesion (arrows) is especially diminished. (Case courtesy of Susan M. Ascher, MD.)

View larger version (168K): [in a new window]   Figure 21b.  Uterine leiomyomas treated with UAE. Sagittal T2-weighted half-Fourier single-shot turbo spin-echo images obtained before UAE (a) and 3 months after UAE (b) show multiple uterine leiomyomas. Both the uterus and the leiomyomas are smaller after UAE (b). The submucosal lesion (arrows) is especially diminished. (Case courtesy of Susan M. Ascher, MD.)

View larger version (197K): [in a new window]   Figure 22a.  Uterine leiomyomas treated with GnRH analog. B = bladder, * in a and c = ovary. Sagittal T2-weighted (a) and contrast-enhanced fat-suppressed T1-weighted (b) images obtained before treatment and T2-weighted image obtained after GnRH analog therapy (c) show multiple uterine leiomyomas. The largest leiomyoma is in the uterine fundus (short arrows). Before treatment, this lesion demonstrates high signal intensity on the T2-weighted image (a) and marked enhancement on the contrast-enhanced image (b). The volume of this lesion is reduced after treatment (c). In contrast, the small leiomyomas in the posterior myometrium (arrowheads) are unchanged after treatment (c). Before treatment, these lesions demonstrate low signal intensity on the T2-weighted image (a) and weak enhancement on the contrast-enhanced image (b). The large leiomyoma in the posterior myometrium (long arrow) is also unchanged after treatment (c), even though it demonstrates enhancement before treatment (b).

View larger version (164K): [in a new window]   Figure 22b.  Uterine leiomyomas treated with GnRH analog. B = bladder, * in a and c = ovary. Sagittal T2-weighted (a) and contrast-enhanced fat-suppressed T1-weighted (b) images obtained before treatment and T2-weighted image obtained after GnRH analog therapy (c) show multiple uterine leiomyomas. The largest leiomyoma is in the uterine fundus (short arrows). Before treatment, this lesion demonstrates high signal intensity on the T2-weighted image (a) and marked enhancement on the contrast-enhanced image (b). The volume of this lesion is reduced after treatment (c). In contrast, the small leiomyomas in the posterior myometrium (arrowheads) are unchanged after treatment (c). Before treatment, these lesions demonstrate low signal intensity on the T2-weighted image (a) and weak enhancement on the contrast-enhanced image (b). The large leiomyoma in the posterior myometrium (long arrow) is also unchanged after treatment (c), even though it demonstrates enhancement before treatment (b).

View larger version (188K): [in a new window]   Figure 22c.  Uterine leiomyomas treated with GnRH analog. B = bladder, * in a and c = ovary. Sagittal T2-weighted (a) and contrast-enhanced fat-suppressed T1-weighted (b) images obtained before treatment and T2-weighted image obtained after GnRH analog therapy (c) show multiple uterine leiomyomas. The largest leiomyoma is in the uterine fundus (short arrows). Before treatment, this lesion demonstrates high signal intensity on the T2-weighted image (a) and marked enhancement on the contrast-enhanced image (b). The volume of this lesion is reduced after treatment (c). In contrast, the small leiomyomas in the posterior myometrium (arrowheads) are unchanged after treatment (c). Before treatment, these lesions demonstrate low signal intensity on the T2-weighted image (a) and weak enhancement on the contrast-enhanced image (b). The large leiomyoma in the posterior myometrium (long arrow) is also unchanged after treatment (c), even though it demonstrates enhancement before treatment (b).

View larger version (138K): [in a new window]   Figure 23a.  Ovarian endometriomas. Axial T1-weighted (a) and T2-weighted (b) images show bilateral ovarian endometriomas with high signal intensity (arrows). High signal intensity on both T1- and T2-weighted images is typical of ovarian endometriomas. The interface between the right and left endometriomas is obscured (so-called kissing ovary). Low-signal-intensity stranding (arrowheads) is seen between the kissing ovary and the sigmoid colon (S), a finding suggestive of fibrous adhesions. * = follicle.

View larger version (147K): [in a new window]   Figure 23b.  Ovarian endometriomas. Axial T1-weighted (a) and T2-weighted (b) images show bilateral ovarian endometriomas with high signal intensity (arrows). High signal intensity on both T1- and T2-weighted images is typical of ovarian endometriomas. The interface between the right and left endometriomas is obscured (so-called kissing ovary). Low-signal-intensity stranding (arrowheads) is seen between the kissing ovary and the sigmoid colon (S), a finding suggestive of fibrous adhesions. * = follicle.

View larger version (117K): [in a new window]   Figure 24a.  Ovarian endometriomas. Axial T1-weighted (a) and T2-weighted (b) images show multiple left ovarian endometriomas. Most of the lesions are hyperintense (arrows); however, one lesion (arrowhead) has low signal intensity on the T2-weighted image (b). Right hydrosalpinx is also seen (H).

View larger version (133K): [in a new window]   Figure 24b.  Ovarian endometriomas. Axial T1-weighted (a) and T2-weighted (b) images show multiple left ovarian endometriomas. Most of the lesions are hyperintense (arrows); however, one lesion (arrowhead) has low signal intensity on the T2-weighted image (b). Right hydrosalpinx is also seen (H).

View larger version (145K): [in a new window]   Figure 25a.  Pelvic endometriosis with severe adhesions. Sagittal fat-suppressed T1-weighted (a) and conventional T2-weighted (b) images show multiple endometrial cysts in the cul-de-sac. Small hyperintense endometriomas are seen on the fat-suppressed T1-weighted image (arrows in a). Posterior displacement of the uterus and an elevated posterior vaginal fornix (arrowheads in b) are suggestive of severe adhesions in the cul-de-sac. In addition, adenomyosis is seen in the posterior serosal aspect of the myometrium (arrows in b).

View larger version (187K): [in a new window]   Figure 25b.  Pelvic endometriosis with severe adhesions. Sagittal fat-suppressed T1-weighted (a) and conventional T2-weighted (b) images show multiple endometrial cysts in the cul-de-sac. Small hyperintense endometriomas are seen on the fat-suppressed T1-weighted image (arrows in a). Posterior displacement of the uterus and an elevated posterior vaginal fornix (arrowheads in b) are suggestive of severe adhesions in the cul-de-sac. In addition, adenomyosis is seen in the posterior serosal aspect of the myometrium (arrows in b).

View larger version (131K): [in a new window]   Figure 26a.  Ovarian endometrioma treated with GnRH analog. Arrowheads = right ovary. (a, b) Axial T1-weighted (a) and T2-weighted (b) images obtained before treatment show a hyperintense cyst (arrows), which represents a left ovarian endometrioma. (c, d) Axial T1-weighted (c) and T2-weighted (d) images obtained after GnRH analog therapy show that the lesion is smaller (arrows) and has low signal intensity on the T2-weighted image (d). Hormonal therapy should be discontinued in such a case because shading is a negative predictor of disease reduction.

View larger version (147K): [in a new window]   Figure 26b.  Ovarian endometrioma treated with GnRH analog. Arrowheads = right ovary. (a, b) Axial T1-weighted (a) and T2-weighted (b) images obtained before treatment show a hyperintense cyst (arrows), which represents a left ovarian endometrioma. (c, d) Axial T1-weighted (c) and T2-weighted (d) images obtained after GnRH analog therapy show that the lesion is smaller (arrows) and has low signal intensity on the T2-weighted image (d). Hormonal therapy should be discontinued in such a case because shading is a negative predictor of disease reduction.

View larger version (139K): [in a new window]   Figure 26c.  Ovarian endometrioma treated with GnRH analog. Arrowheads = right ovary. (a, b) Axial T1-weighted (a) and T2-weighted (b) images obtained before treatment show a hyperintense cyst (arrows), which represents a left ovarian endometrioma. (c, d) Axial T1-weighted (c) and T2-weighted (d) images obtained after GnRH analog therapy show that the lesion is smaller (arrows) and has low signal intensity on the T2-weighted image (d). Hormonal therapy should be discontinued in such a case because shading is a negative predictor of disease reduction.

View larger version (153K): [in a new window]   Figure 26d.  Ovarian endometrioma treated with GnRH analog. Arrowheads = right ovary. (a, b) Axial T1-weighted (a) and T2-weighted (b) images obtained before treatment show a hyperintense cyst (arrows), which represents a left ovarian endometrioma. (c, d) Axial T1-weighted (c) and T2-weighted (d) images obtained after GnRH analog therapy show that the lesion is smaller (arrows) and has low signal intensity on the T2-weighted image (d). Hormonal therapy should be discontinued in such a case because shading is a negative predictor of disease reduction.