Adenomyosis: A Sonographic Diagnosis.

Area of Science:

• Radiology
• Gynecology
• Pathophysiology

Background:

• Adenomyosis is a common benign uterine condition frequently causing pelvic pain in premenopausal women.
• Transvaginal ultrasound (US) is the primary diagnostic imaging modality for adenomyosis.
• Radiologists must be familiar with the sonographic appearance of adenomyosis.

Purpose of the Study:

• To correlate the pathophysiology of adenomyosis with its ultrasound (US) findings.
• To highlight specific causes of adenomyosis.
• To describe how to distinguish adenomyosis from its mimics.

Main Methods:

• Review of adenomyosis pathophysiology and its correlation with US findings.
• Identification of specific inciting causes of adenomyosis.
• Description of diagnostic techniques including cine clips, coronal reformatted images, and saline-infusion sonohysterography.
• Differentiation of adenomyosis from mimics such as leiomyomas and neoplasms.

Main Results:

• US findings of adenomyosis parallel its histology: ectopic endometrial glands (echogenic nodules/striations, myometrial cysts), muscular hyperplasia/hypertrophy (myometrial thickening, globular uterus), and increased vascularity (penetrating vessels on Doppler US).
• Heterogeneous myometrium with a blurred endometrial border is characteristic.
• Specific techniques like cine clips, coronal reformatted images, and saline-infusion sonohysterography aid diagnosis.
• Causes include spontaneous development, tamoxifen use, postendometrial ablation syndrome, and deep-infiltrating endometriosis.

Conclusions:

• Transvaginal US is crucial for diagnosing adenomyosis by identifying characteristic sonographic features.
• Understanding the pathophysiology and recognizing specific US findings are key to accurate diagnosis.
• Differentiating adenomyosis from mimics is essential for appropriate patient management.