MR imaging of diffuse adenomyosis changes after GnRH analog therapy

Area of Science:

• Reproductive Medicine
• Medical Imaging
• Endocrinology

Background:

• Adenomyosis is a common gynecological condition characterized by the infiltration of endometrial tissue into the myometrium.
• Diffuse adenomyosis presents diagnostic challenges, often involving diffuse widening of the junctional zone (JZ).
• Magnetic resonance imaging (MRI) is crucial for evaluating uterine morphology in adenomyosis.

Purpose of the Study:

• To assess uterine changes on MRI following gonadotropin-releasing hormone analog (GnRHa) treatment in patients with diffuse adenomyosis.
• To compare the treatment response between symmetric and asymmetric subtypes of diffuse adenomyosis.
• To investigate the impact of GnRHa on junctional zone (JZ) width and signal intensity (SI) foci.

Main Methods:

• Thirty-one patients with diffuse adenomyosis underwent MRI before and after 6 months of GnRHa therapy.
• Diffuse adenomyosis was classified as symmetric (entire JZ widening) or asymmetric (partial JZ widening).
• Pre- and post-treatment MRI parameters analyzed included JZ width, high SI foci, and demarcated change.

Main Results:

• After GnRHa treatment, a significant decrease in JZ width was observed (P < 0.0001).
• Asymmetric adenomyosis cases (15/18) initially showed high SI foci, which resolved post-treatment.
• Eight cases of asymmetric adenomyosis exhibited demarcated changes and resolved high SI foci, unlike symmetric cases.

Conclusions:

• GnRHa treatment effectively reduces JZ width in patients with diffuse adenomyosis.
• Asymmetric adenomyosis with high SI foci demonstrates a significant positive response to hormonal therapy.
• MRI findings indicate GnRHa is a potential therapeutic option for managing diffuse adenomyosis, particularly the asymmetric subtype.