Abstract:
HTML
Purpose: Recent studies have suggested that transvaginal ultrasound approaches pelvic MRI in sensitivity and specificity for the diagnosis of adenomyosis. The purpose of this investigation is to assess added diagnostic value of pelvic MRI when performed after a transvaginal pelvic ultrasound(TVUS) that has diagnosed uterine adenomyosis.
Methods and Materials: Retrospective review of imaging database from 1/1/01 to 1/1/03 found 65 patients( age 36-53 mean 46) with US suspicion of adenomyosis who subsequently underwent pelvic MRI exam within 30 days of the TVUS. The TVUS and MR examinations were then prospectively interpreted by a single subspecialist in womens imaging. The TVUS was considered diagnostic for adenomyosis if at least 3 of 6 diagnostic criteria were present (myometrial cysts, asymmetric myometrial thickening, enlarged uterus, globular shaped uterus, small echogenic myometrial nodules, pain during sonographic examination of the uterus). 8/65 patients were eliminated based on the lack of qualifying sonographic criteria. 57 patients were included in the study. The MRI was considered confirmatory for the diagnosis of adenomyosis if any one of three major diagnostic criteria was present (junctional zone(JZ) thickness> 12mm, JZ cysts, JZ indistinct).
Results: 25 of the 57 patients with sonographic suspicion of adenomyosis had no MR evidence of adenomyosis (44%). In 19 of these patients (33%), the findings at US were explained by an alternate diagnosis (multiple small myometrial fibroids n=18, uterine AVM n=1). The remaining 6 (11%) had a normal appearing uterus on MRI without any explanation of sonographic findings. No additional adnexal findings not identified by TVUS were observed on MRI in these 25 patients. 32/57 patients had MRI confirmation of adenomyosis (66%). Of these, 25 had additional findings not suspected on TVUS (44%). 20/32 were found to have myometrial fibroids in addition to the adenomyosis. 11/32 had unsuspected findings within the adnexae associated with endometriosis, (endometrioma n=2, serosal implants n=11).
Conclusion: MRI gives important added value after TVUS diagnosis of adenomyosis in 88% of patients by providing a diagnostic alternative in 33%, otherwise questioning the diagnosis in an additional 11%, and by providing supplementary diagnostic information in another 44%.
Zacharia MD, T,
Pelvic MRI in Patients with Transvaginal Ultrasound Diagnosis of Adenomyosis: What Does MRI Add to the Overall Patient Evaluation?. Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL.
http://archive.rsna.org/2003/3108344.html
