ABSTRACT
Magnetic resonance imaging(MRI)is one of the important imaging methods for the female reproductive system.In recent years,its application value in uterine adenomyosis has been increasingly recognized in clinic.Due to its many advantages,such as clear and intuitive images,being independent of operators,multi-parameter and multi-planar imaging and so on,MRI has been mainly applied to the diagnosis and typing of uterine adenomyosis and the continuous monitoring after drug treatment.The purpose of this article is to review the manifestations and typing of uterine adenomyosis in MRI and the progress of MRI scanning technology.
ABSTRACT
Objective To investigate the value of abnormal thickening of the junctional zone, and T1 weighted imaging (WI) and (or) T2WI hyperintense in magnetic resonance imaging (MRI) for the diagnosis of uterine adenomyosis. Methods The MRI images of 37 cases of adenomyosis confirmed by pathology in Changhai Hospital of Navy Medical University (Second Military Medical University) from Jan. 2013 to Jan. 2016 were retrospectively analyzed, and 37 cases of normal uterus and ovary confirmed by MRI in the same period were randomly selected as controls. The maximal junctional zone thickness (JZmax), the difference between the smallest and largest junctional zone thickness (JZdiff), and the ratio of JZmax to maximal myometrium thickness (JZmax/ Mmax) were measured and compared between the two groups. The receiver operating characteristic (ROC) curve of each parameter in diagnosis of adenomyosis was drawn, and the area under curve (AUC), cut-off value, sensitivity, specificity and accuracy were calculated. In addition, the T1WI and T2WI hyperintense and their types in the uterine wall were observed. Results There were significant differences in JZmax, JZdiff and JZmax/Mmax between the adenomyosis and control groups (all P<0.01). The AUC for the diagnosis of adenomyosis by JZmax JZdiff, and JZmax/Mmax were 0.95, 0.90, and 0.85, respectively. When JZmax≥10 mm, the sensitivity, specificity and accuracy were 78.8%, 97.3% and 88.6%, respectively; when JZdiff≥3.4 mm, those were 81.8%, 91.9% and 87.1%, respectively; When JZmax/Mmax≥61%, those were 72.7%, 83.8% and 78.6%, respectively. Eighteen cases (48.6%) had only T2WI hyperintense, while 14 cases (37.8%) had both T1WI and T2WI hyperintense; most of them showed snowdrift sign on T1WI and (or) T2WI. T1WI and (or) T2WI showed linear stripe sign in 5 cases (13.5%), microcapsule sign in 5 cases (13.5%), and cystic hemorrhage syndrome in 1 case (2.7%). Conclusion JZmax≥10 mm, JZdiff≥3.4 mm and JZmax/Mmax≥61% have significant diagnostic value in diagnosis of adenomyosis, and JZmax has the best diagnostic efficiency. Snowdrift sign, linear stripe sign, microcapsule sign and cystic hemorrhage sign on T1WI and (or) T2WI are unique for the diagnosis of adenomyosis. Comprehensive evaluation of the above signs can improve the diagnostic value of MRI and early accurate diagnosis of adenomyosis.
ABSTRACT
Objective The purpose of this study was to compare the adenomyosis models in nude mice generated by four different methods,and to find out an optimal modeling method, and to provide an ideal animal model for exploring pathogenesis and experimental treatment of uterine adenomyosis. Methods 1. 80 female healthy nude mouse were divided randomly into 4 groups: Intraperitoneal implantation group, subcutaneous implantation group, intraperitoneal injection group, and subcutaneous injection group. The transplants were taken for pathological examination at 4 weeks after surgery. Results The success rate of intraperitoneal implantation group was 95%,and that of the subcutaneous implantation group was 45%,while the success rate of intraperitoneal injection group and subcutaneous injection group was 0%. Conclusions Establishment of a nude mouse model of uterine adenomyosis by intraperitoneal implantation method has a high success rate and with good stability, and is an ideal mouse model of human-derived uterine adenomyosis.
ABSTRACT
Objective To observe and analyze the therapeutic effect of focal uterine adenomyosis treated with percutaneous microwave ablation by contrast-enhanced ultrasound and dynamic contrast enhanced MRI (DCE-MRI).Methods From January 2013 to July 2016,42 patients with focal uterine adenomyosis voluntarily underwent percutaneous microwave ablation in the tumor hospital of Liaocheng.Contrast-enhanced ultrasound and DCE-MRI were performed before and after percutaneous microwave ablation.The therapeutic effects of percutaneous microwave ablation in treatment of uterine adenomyosis lesions were observed.Results After percutaneous microwave ablation of the 42 cases,the ablated zone showed no enhancement with contrast-enhanced ultrasound and DCE-MRI.Contrast-enhanced ultrasound showed that the volume and ablation rate of ablated zone were (49.0±29.5) cm3 and (91.6± 7.1)％,and that of DCE-MRI were (49.4 ± 29.9)cm3 and (91.9 ± 6.7)％,respectively.The results showed that percutaneous microwave ablation could cure focal uterine adenomyosis at the rate over 90％.Contrast-enhanced ultrasoundand DCE-MRI are in accordance in observing the ablation rate.Conclusions Contrast-enhanced ultrasound can accurately show the ablation rate of focal uterine adenomyosis treated with percutaneous microwave ablation,which is quite consistent with DCE-MRI.Contrast-enhanced ultrasound has its advantages such as identifying the lesions which need immiedately supplemental ablation.
ABSTRACT
Objective The adverse reactions of levonorgestrel releasing intrauterine system ( LNG-IUS) has been emphasized with the increase of its indications.The study was to investigate the feasibility of interventional treatment in treating uterine adenomyosis with LNG-IUS by observing its adverse reactions, trying to reduce its adverse reaction, increase its utilization ratio and service life and improve its efficacy. Methods Retrospective analysis was made on 67 patients with uterine adenomyosis who were willing to accept LNG-IUS treatment from January 2012 to December 2013 in our hospital.The patients were randomly divided into observation group ( n=34) and control group( n=34) according to different therapies.The observation group were given interventional treatment immedi-ately after the placement of LNG-IUS, that is to take oral non-steroidal anti-inflammatory drug ( indomethacin, 25 mg, 1 pill each time, three times a day) for 7 consecutive days and desogestrel-ethinylestradiol ( marvelon, 1 pill a day) for 21 consecutive 21 days, 3 con-secutive cycles;while the control group were only given communications without any special treatment.Observation and record were made on related adverse reactions at 1 month, 3 months and 6 months after the treatment. Results At 1 month, 3 months and 6 months after the interventional treatment, the incidence rates of abnormal uterine bleeding between two groups were of significant difference ( 23.5%vs 60.6%, 11.7%vs 36.4%, 0%vs 12.1%, P<0.05) in the control group. At 6 month after the treatment, statistical difference was found in the total incidence rates of amenorrhea, ovarian cysts, dislocation and out of place of IUD between these two groups ( 23.5%vs 6.1%, 2.9%vs 21.2%, 2.9%vs 18.2%, P<0.05). Conclusion The research has indicated that the adoption of interventional treatment after placing LNG-IUS can obviously reduce the occurrence of the main adverse reactions, so it is feasible in clinical application.
ABSTRACT
Objective To evaluate the effect of contrast-enhanced ultrasound(CEUS) in the real-time monitoring treatment of ultrasound-guided high intensity focused ultrasound (HIFU ) for uterine adenomyosis .Methods From January 2013 to September 2013 ,a total of 67 patients who were clinically diagnosticated as uterine adenomyosis were enrolled in this study .49 patients were diffuse type and 18 patients were localized .CEUS was used before ,in ,after ultrasonic treatment to make sure lesions and evaluate the ablation effect .Results 67 patients were 100% perfused before HIFU treatment by CEUS ,the non-perfused volume ratio of 15 patients(22 .4% ) were not enough during treatment ,and more energy were given .During HIFU treatment ,uniform grey scale change was observed in 42 of 67(62 .7% ) patients and massive grey scale change was observed in 25 of 67(37 .3% ) patients .The margin of targets and the non-perfused volume were clearly detected by CEUS .The size of target andymyosis ,the volume ,the non-perfused volume ,and non-perfused volume ratio were(4 .8 ± 1 .5)cm ,(63 .1 ± 57 .2)cm3 ,(59 .1 ± 53 .4 )cm3 ,(76 .4 ± 27 .0)% .The adverse effects occurred in the treatment were not related to CEUS .Conclusion CEUS is an accurate method in assessing the treat-ment effect of HIFU and could be safely used during HIFU treatment for uterine adenomyosis .
ABSTRACT
Mayer-Rokitansky-Kuster-Hauser syndrome (MRKHS) is characterized by vaginal agenesis with variable Mullerian duct abnormalities. We report here a case of uterine adenomyosis which developed from a hypoplastic uterus in a patient with MRKHS. A 55-year-old postmenopausal woman visited a university hospital for pelvic mass. She had underwent vaginoplasty via the McIndoe procedure for MRKHS at 15 years of age. Pelvic magnetic resonance imaging showed a 5.4 x 4.8 x 4.7 cm mass suspicious for a uterine myoma. She received total abdominal hysterectomy with bilateral salpingo-oophorectomy, and neither the cervix nor endometrium was found grossly in the surgical specimen. The final histologic diagnosis was uterine adenomyosis.
Subject(s)
Female , Humans , Middle Aged , Adenomyosis , Cervix Uteri , Diagnosis , Endometrium , Hysterectomy , Leiomyoma , Magnetic Resonance Imaging , UterusABSTRACT
Adenomyosis has been well known to be associated with infertility, spontaneous rupture of the uterus during labor in a primiparous woman, spontaneous preterm labor, preterm premature rupture of membranes (PPROM), and delayed postpartum hemorrhage. We recently experienced a case of preterm delivery at 29 gestational weeks in a primigravid woman with uterine adenomyosis. We report the case of preterm delivery accompanied by various complications such as uncontrolled pain, preterm labor, and oligohydramnios in a woman with uterine adenomyosis.
Subject(s)
Female , Humans , Pregnancy , Abdominal Pain , Adenomyosis , Infertility , Membranes , Obstetric Labor, Premature , Oligohydramnios , Postpartum Hemorrhage , Premature Birth , Rupture , Rupture, Spontaneous , UterusABSTRACT
Objective To explore the clinical value of laparoscopic supracervical hysterectomy (LSH). Methods From July 2006 to September 2007,78 cases of LSH and 59 cases of abdominal supracervical hysterectomy (ASH) were performed in our hospital. The clinical data of the patients,including intraoperative blood loss,operation time,recovery time of bowel movement,postoperative time of out-of-bed activity and postoperative hospital stay,were analyzed and compared between the two groups.Results No significant difference was found on the mean intraoperative blood loss between the LSH group and ASH group [(65.1?25.5) ml vs (72.9?23.6) ml,t=-1.830,P=0.069]. Whereas,the LSH group had significantly longer operation time and earlier recovery of the gastrointestinal function [(80.3?29.6) min vs (62.4?13.1) min,t=4.332,P=0.000;and (26.5?8.5) h vs (30.9?7.0) h,t=-3.232,P=0.001]. Furthermore,the LSH patients had out-of-bed activity and were discharged from hospital significantly earlier than the ASH group [(32.8?6.7) h vs (40.4?9.7)h,t=-5.421,P=0.000;and (7.1?0.6) d vs (7.9?0.5) d,t=-8.291,P=0.000]. No major complication occurred in both the groups. Conclusions LSH shows great advantages over ASH. As long as surgeons are skilled in laparoscopic operation,LSH can be an ideal procedure for hysterectomy.
ABSTRACT
Uterine adenomyosis is a common benign pelvic tumor in women. One of the complications that may be infrequently associated with the huge pelvic mass is venous stasis of the lower extremities and may develop thrombophlebitis secondary to pelvic compression. Intravascular thrombosis in the deep vein of the legs is a serious illness that sometimes cause death due to acute pulmonary thromboembolism. Deep vein thrombosis (DVT) has been reported to be closely related to pregnancy, surgical procedure, long term bedrest, obesity, and oral contraceptives. However, there is few report about deep vein thrombosis caused by huge uterine adenomyosisWe report a case of deep vein thrombosis caused by huge adenomyosis was treated by hysterectomy, thrombectomy, and thrombolysis with a brief review of the literature.
Subject(s)
Female , Humans , Pregnancy , Adenomyosis , Bed Rest , Contraceptives, Oral , Hysterectomy , Leg , Lower Extremity , Obesity , Pulmonary Embolism , Thrombectomy , Thrombophlebitis , Thrombosis , Veins , Venous ThrombosisABSTRACT
PURPOSE: To analyze the enhancement patterns of adenomyosis and evaluate the usefulness of dynamic MR imaging in detecting adenomyosis. MATERIALS AND METHODS: Dynamic MR imaging finding in 46 women with adenomyosis were analyzed retrospectively. Dynamic MR imaging was obtained in each patient. Fifteen consecutive FLASH images were obtained before, immediately after and 15, 30, 45, 90 second and 5 minute after bolus injection of Gd-DOTA. Signal intensities of adenomyosis and outer myometrium and standard deviations of image noise were measured using an electronic cursor. Contrast-to-noise ratio (C/N) of the lesion to outer myometrium were calculated as follows ; (signal intensity of outer myometrium-signal intensity of adenomyosis)/(standard deviation) of noise signal intensity. RESULTS: The mean signal intensity of adenomyosis was higher than surrounding outer myometrium before and immediately after contrast injection. On 15, 30, 45, 90 second, and 5 minute after injection the signal intensity of adenomyosis was lower than that of surrounding outer myometrium (p < 0.05). The mean C/N values between adenomyosis and surrounding myometrium on precontrast scan, immediate postcontrast, and 15, 30, 45, 90 second and 5 minute delayed images were 3.20, 5.03, 6.14, 6.87, 7.13, 7.78, 38.59, respectively. On T2-weighted images, the mean C/N value between adenomyosis and surrounding myometrium was 16.7. Mean C/N value between adenomyosis and surrounding myometrium on delayed images was significantly higher than those of other dynamic & T2-weighted images(p<0.05). CONCLUSION: Dynamic MR imaging is very useful in the evaluation of the enhancement pattern and especially in detection of adenomyosis because the mean C/N value between adenomyosis and surrounding myometrium on delayed images are higher than that of T2-weighted images.