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Diffuse and Focal Adenomyosis: MR Imaging Findings¹

¹ From the Department of Radiology, Kangnam St Mary's Hospital, College of Medicine, Catholic University of Korea, 505 Banpo-dong, Seocho-ku, Seoul 137-040, Korea. Presented as a scientific exhibit at the 1998 RSNA scientific assembly. Received January 28, 1999; revision requested April 16 and received May 10; accepted May 11. Address reprint requests to J.Y.B.

View larger version (145K): [in a new window]   Figures 1, 2.   (1) Mild diffuse adenomyosis in a 42-year-old woman. (a) Sagittal T1-weighted MR image shows a mildly enlarged anteverted uterus. The junctional zone is isointense relative to the myometrium. (b) Sagittal T2-weighted MR image shows diffuse, even thickening of the junctional zone (arrows), a finding consistent with diffuse adenomyosis. (c) Sagittal contrast-enhanced fat-suppressed delayed T1-weighted MR image shows obliteration of the margin of the thickened junctional zone, a finding that is of no particular value in diagnosing adenomyosis. (2) Extensive involvement of diffuse adenomyosis in a 42-year-old woman. Sagittal T2-weighted MR image demonstrates diffuse areas of low signal intensity involving most of the uterus (straight arrows) and punctate high-signal-intensity foci (arrowhead). A few small nabothian cysts (curved arrows) are seen in the uterine cervix.

View larger version (199K): [in a new window]   Figures 1, 2.   (1) Mild diffuse adenomyosis in a 42-year-old woman. (a) Sagittal T1-weighted MR image shows a mildly enlarged anteverted uterus. The junctional zone is isointense relative to the myometrium. (b) Sagittal T2-weighted MR image shows diffuse, even thickening of the junctional zone (arrows), a finding consistent with diffuse adenomyosis. (c) Sagittal contrast-enhanced fat-suppressed delayed T1-weighted MR image shows obliteration of the margin of the thickened junctional zone, a finding that is of no particular value in diagnosing adenomyosis. (2) Extensive involvement of diffuse adenomyosis in a 42-year-old woman. Sagittal T2-weighted MR image demonstrates diffuse areas of low signal intensity involving most of the uterus (straight arrows) and punctate high-signal-intensity foci (arrowhead). A few small nabothian cysts (curved arrows) are seen in the uterine cervix.

View larger version (165K): [in a new window]   Figures 1, 2.   (1) Mild diffuse adenomyosis in a 42-year-old woman. (a) Sagittal T1-weighted MR image shows a mildly enlarged anteverted uterus. The junctional zone is isointense relative to the myometrium. (b) Sagittal T2-weighted MR image shows diffuse, even thickening of the junctional zone (arrows), a finding consistent with diffuse adenomyosis. (c) Sagittal contrast-enhanced fat-suppressed delayed T1-weighted MR image shows obliteration of the margin of the thickened junctional zone, a finding that is of no particular value in diagnosing adenomyosis. (2) Extensive involvement of diffuse adenomyosis in a 42-year-old woman. Sagittal T2-weighted MR image demonstrates diffuse areas of low signal intensity involving most of the uterus (straight arrows) and punctate high-signal-intensity foci (arrowhead). A few small nabothian cysts (curved arrows) are seen in the uterine cervix.

View larger version (179K): [in a new window]   Figures 1, 2.   (1) Mild diffuse adenomyosis in a 42-year-old woman. (a) Sagittal T1-weighted MR image shows a mildly enlarged anteverted uterus. The junctional zone is isointense relative to the myometrium. (b) Sagittal T2-weighted MR image shows diffuse, even thickening of the junctional zone (arrows), a finding consistent with diffuse adenomyosis. (c) Sagittal contrast-enhanced fat-suppressed delayed T1-weighted MR image shows obliteration of the margin of the thickened junctional zone, a finding that is of no particular value in diagnosing adenomyosis. (2) Extensive involvement of diffuse adenomyosis in a 42-year-old woman. Sagittal T2-weighted MR image demonstrates diffuse areas of low signal intensity involving most of the uterus (straight arrows) and punctate high-signal-intensity foci (arrowhead). A few small nabothian cysts (curved arrows) are seen in the uterine cervix.

View larger version (184K): [in a new window]   Figure 3a.   Diffuse, uneven adenomyosis in a 42-year-old woman. Sagittal T2-weighted (a) and contrast-enhanced fat-suppressed delayed T1-weighted (b) MR images show diffuse, nonuniform thickening of the junctional zone subjacent to the endometrium (arrows), a finding that is diagnostic for adenomyosis. Note the presence of several high-signal-intensity foci (arrowheads in a) representing nonbleeding foci of endometrial tissue.

View larger version (156K): [in a new window]   Figure 3b.   Diffuse, uneven adenomyosis in a 42-year-old woman. Sagittal T2-weighted (a) and contrast-enhanced fat-suppressed delayed T1-weighted (b) MR images show diffuse, nonuniform thickening of the junctional zone subjacent to the endometrium (arrows), a finding that is diagnostic for adenomyosis. Note the presence of several high-signal-intensity foci (arrowheads in a) representing nonbleeding foci of endometrial tissue.

View larger version (184K): [in a new window]   Figure 4a.   Diffuse adenomyosis with cervical cancer and hydrometra in a 65-year-old woman. On sagittal T2-weighted (a) and contrast-enhanced fat-suppressed T1-weighted (b) MR images, the junctional zone is not clearly visible because of compression of the junctional zone by hydrometra (H). The hydrometra is caused by a large obstructing mass in the uterine cervix (arrows).

View larger version (164K): [in a new window]   Figure 4b.   Diffuse adenomyosis with cervical cancer and hydrometra in a 65-year-old woman. On sagittal T2-weighted (a) and contrast-enhanced fat-suppressed T1-weighted (b) MR images, the junctional zone is not clearly visible because of compression of the junctional zone by hydrometra (H). The hydrometra is caused by a large obstructing mass in the uterine cervix (arrows).

View larger version (175K): [in a new window]   Figure 5a.   Focal adenomyosis in a 35-year-old woman. Axial (a) and sagittal (b) T2-weighted MR images show an ill-defined, circumscribed area of low signal intensity within the myometrium (straight arrows) and punctate foci of high signal intensity (arrowheads in b). There are multiple small signal voids (curved arrows) representing intramuscular vessels, which may mimic leiomyoma. A small ovarian cyst (C in a) is noted incidentally.

View larger version (183K): [in a new window]   Figure 5b.   Focal adenomyosis in a 35-year-old woman. Axial (a) and sagittal (b) T2-weighted MR images show an ill-defined, circumscribed area of low signal intensity within the myometrium (straight arrows) and punctate foci of high signal intensity (arrowheads in b). There are multiple small signal voids (curved arrows) representing intramuscular vessels, which may mimic leiomyoma. A small ovarian cyst (C in a) is noted incidentally.

View larger version (160K): [in a new window]   Figure 6.   Focal adenomyosis in a 31-year-old woman. Axial T2-weighted MR image demonstrates an ill-defined mass with low signal intensity within the myometrium of the uterine fundus (arrows). Multiple punctate foci of high signal intensity, which are thought to represent hemorrhagic endometrial nests, are scattered throughout the mass (arrowheads). These foci were also seen on T1-weighted images (not shown).

View larger version (159K): [in a new window]   Figure 7a.   Focal adenomyosis in a 37-year-old woman. Axial (a) and sagittal (b) T2-weighted MR images demonstrate a well-defined, ovoid, low-signal-intensity mass within the myometrium mimicking leiomyoma (arrows).

View larger version (173K): [in a new window]   Figure 7b.   Focal adenomyosis in a 37-year-old woman. Axial (a) and sagittal (b) T2-weighted MR images demonstrate a well-defined, ovoid, low-signal-intensity mass within the myometrium mimicking leiomyoma (arrows).

View larger version (190K): [in a new window]   Figure 8.   Focal adenomyosis in a 44-year-old woman. Sagittal T2-weighted MR image shows an ill-defined, low-signal-intensity mass within the myometrium (black arrows) that appears to wrap around the endometrium (white arrows). Multiple high-signal-intensity foci are also seen (arrowheads).

View larger version (178K): [in a new window]   Figure 9a.   Focal adenomyosis associated with endometriosis in a 28-year-old woman. Axial T1-weighted (a) and T2- weighted (b) MR images demonstrate ill-defined focal adenomyosis (solid arrows in b) in the posterior uterine wall compressing the endometrial cavity (open arrows in b). The lesion is located away from the endometrium. There are small adnexal masses (E) with high signal intensity in a and characteristic shading in b representing endometriomas.

View larger version (161K): [in a new window]   Figure 9b.   Focal adenomyosis associated with endometriosis in a 28-year-old woman. Axial T1-weighted (a) and T2- weighted (b) MR images demonstrate ill-defined focal adenomyosis (solid arrows in b) in the posterior uterine wall compressing the endometrial cavity (open arrows in b). The lesion is located away from the endometrium. There are small adnexal masses (E) with high signal intensity in a and characteristic shading in b representing endometriomas.

View larger version (167K): [in a new window]   Figure 10a.   Focal adenomyosis associated with endometriosis and signal voids in a 50-year-old woman. Sagittal T2-weighted (a) and contrast-enhanced fat-suppressed T1-weighted (b) MR images demonstrate ill-defined focal adenomyosis (straight solid arrows) and high-signal-intensity foci (arrowheads in a) within the anterior myometrium with compression of the endometrial cavity (curved arrows). There are multiple small signal voids (open arrows) representing intramuscular vessels, which may mimic leiomyoma. An ovoid mass with a signal intensity that is characteristic of endometrioma (E) is located superior to the uterine fundus.

View larger version (166K): [in a new window]   Figure 10b.   Focal adenomyosis associated with endometriosis and signal voids in a 50-year-old woman. Sagittal T2-weighted (a) and contrast-enhanced fat-suppressed T1-weighted (b) MR images demonstrate ill-defined focal adenomyosis (straight solid arrows) and high-signal-intensity foci (arrowheads in a) within the anterior myometrium with compression of the endometrial cavity (curved arrows). There are multiple small signal voids (open arrows) representing intramuscular vessels, which may mimic leiomyoma. An ovoid mass with a signal intensity that is characteristic of endometrioma (E) is located superior to the uterine fundus.

View larger version (165K): [in a new window]   Figure 11.   Focal adenomyosis associated with leiomyoma in a 47-year-old woman. Sagittal T2-weighted MR image shows ill-defined focal adenomyosis (solid arrows) with high-signal-intensity foci (arrowheads) in the anterior uterine wall coexisting with a small, well-circumscribed, low-signal-intensity leiomyoma (open arrows).