子宫腺肌病.pptVIP

Adenomyosis: Usual andUnusual Imaging Manifestations,Pitfalls, andProblem-solving MR Imaging Techniques Mayumi Takeuchi,et al RadioGraphics 2011 Introduction Adenomyosis is a common nonneoplastic gynecologic disease characterized by the presence of ectopic endometrium within the myometrium. Adenomyosis may affect the uterine myometrium diffusely and result in a diffusely enlarged uterus, or it may be localized as an adenomyoma. MR Imaging Manifestationsof Typical Adenomyosis Typical adenomyosis appears as an ill-demarcated low-signal-intensity area on T2-weighted images owing to abundant smooth muscle proliferation. On T2-weighted MR images, ectopic endometrium appears as small high-signal-intensity areas. Hemorrhagic foci appear as high-signal-intensity foci on T1-weighted images. Problem-solving MR Imaging Techniques Diffusion-weighted Imaging Susceptibility-weighted Imaging 1H MR Spectroscopy Cine MR Imaging High-Resolution MR Imaging at 3 T Atypical MR ImagingManifestations of Adenomyosis Congestion or edematous change may also increase the signal intensity of adenomyosis diffusely or focally on T2-weighted images. After hormonal therapy or menopause, an area of adenomyosis may shrink with decreased signal intensity on T2-weighted images. Pitfalls in Diagnosis of Adenomyosis Physiologic Changes in the Uterine Body during the Menstrual Cycle Increased signal intensity of the myometrium in the secretory phase (luteal phase). Decreased signal intensity of the myometrium in the menstrual–early proliferative phase (follicular phase) may cause widening of the junctional zone, which mimics diffuse adenomyosis. Therefore, MR imaging for the evaluation of a uterine myometrial lesion should be performed in the late proliferative–secretory phase. Benign and Malignant Mimics of Adenomyosis Various benign conditions and malignant tumors may mimic adenomyosis: physiologic myometrial contraction, myometrial involvement by pelvic endometriosis, low-g