Major diagnostic signs of magnetic resonance imaging for uterine adenomyosis / 第二军医大学学报

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.