Imaging the Endometrium: Disease and Normal Variants1
Kenneth M. Nalaboff, MD,
John S. Pellerito, MD and
Eran Ben-Levi, MD
1 From the Department of Radiology, North Shore University Hospital, 300 Community Dr, Manhasset, NY 11030. Presented as a scientific exhibit at the 1999 RSNA scientific assembly. Received November 17, 2000; revision requested January 17 and received August 1; accepted August 8. Address correspondence to J.S.P. (e-mail: johnp@nshs.edu).
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Figure 1. Normal pediatric endometrium. Sagittal US image of the uterus in a 2-year-old girl demonstrates a thin endometrium (arrow).
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Figure 2. Hematometrocolpos in a 12-year-old girl with abdominal pain. Sagittal US image demonstrates a markedly distended vagina (straight arrow) and uterine cavity (curved arrow).
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Figure 3. Normal premenopausal endometrium. Sagittal US image of the uterus obtained during menstruation shows a thin endometrial lining (arrow) with a trace of fluid.
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Figure 4. Normal premenopausal endometrium. Sagittal US image of the uterus obtained during the late proliferative phase of the menstrual cycle demonstrates the endometrium with a multilayered appearance (arrows).
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Figure 5. Normal premenopausal endometrium. Sagittal US image of the uterus obtained during the secretory phase of the menstrual cycle shows a thickened, echogenic endometrium (cursors).
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Figure 6. Normal premenopausal endometrium. T2-weighted MR image shows the normal endometrium (straight arrow) and junctional zone (curved arrow).
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Figure 7. Double decidual sac sign. US image of an early IUP demonstrates two hyperechoic rings (arrows). The inner ring represents the combined chorion-decidua capsularis, and the outer ring represents the decidua parietalis.
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Figure 8. Decidual cast. Transabdominal US image reveals echogenic material within the endometrium (cursors).
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Figure 9. Blighted ovum. US image shows the gestational sac with no visible embryo or yolk sac. A small subchorionic hematoma is noted (arrow).
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Figure 10. Pseudogestational sac. Transvaginal color Doppler US image demonstrates an irregular saclike structure in the endometrial canal (arrows), normal flow in the myometrium, and decreased vascularity adjacent to the pseudogestational sac.
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Figure 11. Molar pregnancy. US image demonstrates an echogenic mass in the uterine cavity with multiple small, hyperechoic areas (arrowheads).
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Figure 12. Endometritis. US image demonstrates multiple echogenic foci within the endometrium (arrow) representing gas.
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Figure 13a. RPOC. (a) US image shows echogenic material within the endometrial canal (arrows). (b) Color Doppler US image (shown in black and white) demonstrates low-resistance arterial flow within RPOC. Peak systolic velocity was 22 cm/sec.
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Figure 13b. RPOC. (a) US image shows echogenic material within the endometrial canal (arrows). (b) Color Doppler US image (shown in black and white) demonstrates low-resistance arterial flow within RPOC. Peak systolic velocity was 22 cm/sec.
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Figure 14. RPOC with calcifications. US image shows echogenic material with posterior acoustic shadowing (arrow), a finding that is consistent with calcified RPOC.
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Figure 15. Postmenopausal endometrial atrophy. Transvaginal US image demonstrates a postmenopausal endometrium with thin walls and outlined with fluid.
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Figure 16. Postmenopausal endometrial atrophy. T2-weighted MR image demonstrates an atrophic postmenopausal endometrium (arrows).
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Figure 17. Endometrial polyp. Sonohysterogram reveals a small polyp attached by a stalk to the endometrium (black arrow). An echogenic focus in the endometrial cavity (white arrow) represents injected air.
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Figure 18. Endometrial polyp. Anteroposterior (left) and oblique (right) hysterosalpingograms demonstrate a pedunculated filling defect within the uterine cavity (arrows).
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Figure 19. Endometrial polyp. T2-weighted MR image demonstrates a low-signal-intensity lesion within the endometrial canal (arrow).
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Figure 20a. Submucosal fibroid. (a) Transvaginal US image reveals a uterine mass (arrows) with posterior acoustic shadowing. (b) Sonohysterogram reveals that the mass is submucosal in location, a finding that is consistent with an echogenic fibroid.
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Figure 20b. Submucosal fibroid. (a) Transvaginal US image reveals a uterine mass (arrows) with posterior acoustic shadowing. (b) Sonohysterogram reveals that the mass is submucosal in location, a finding that is consistent with an echogenic fibroid.
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Figure 21. Submucosal fibroids. Oblique (left) and anteroposterior (right) hysterosalpingograms demonstrate smooth filling defects distorting the uterine cavity and representing submucosal fibroids.
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Figure 22. Submucosal fibroids. T2-weighted MR image shows a hypointense submucosal fibroid splaying the endometrium (arrows).
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Figure 23. Endometrial hyperplasia. US image shows an endometrium with diffuse thickening (maximum thickness, 1.74 cm) due to hyperplasia (cursors). This finding was confirmed at biopsy.
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Figure 24a. Endometrial adenocarcinoma. (a) US image reveals a heterogeneous endometrial mass (arrows) that is difficult to distinguish from the myometrium. Cursors indicate the entire transverse width of the uterus. (b) T2-weighted MR image shows a large, heterogeneous tumor distending the endometrial canal (arrows). (c) CT scan also reveals a heterogeneous tumor (arrowheads).
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Figure 24b. Endometrial adenocarcinoma. (a) US image reveals a heterogeneous endometrial mass (arrows) that is difficult to distinguish from the myometrium. Cursors indicate the entire transverse width of the uterus. (b) T2-weighted MR image shows a large, heterogeneous tumor distending the endometrial canal (arrows). (c) CT scan also reveals a heterogeneous tumor (arrowheads).
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Figure 24c. Endometrial adenocarcinoma. (a) US image reveals a heterogeneous endometrial mass (arrows) that is difficult to distinguish from the myometrium. Cursors indicate the entire transverse width of the uterus. (b) T2-weighted MR image shows a large, heterogeneous tumor distending the endometrial canal (arrows). (c) CT scan also reveals a heterogeneous tumor (arrowheads).
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Figure 25a. Endometrial thickening associated with tamoxifen therapy. (a) US image reveals marked endometrial thickening (arrowheads) associated with subendometrial cysts (arrows) resulting from tamoxifen therapy. (b) Sonohysterogram demonstrates that the endometrial thickening is secondary to a large polyp (arrows).
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Figure 25b. Endometrial thickening associated with tamoxifen therapy. (a) US image reveals marked endometrial thickening (arrowheads) associated with subendometrial cysts (arrows) resulting from tamoxifen therapy. (b) Sonohysterogram demonstrates that the endometrial thickening is secondary to a large polyp (arrows).
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Figure 26. Endometrial thickening associated with tamoxifen therapy. T2-weighted MR image shows a thickened endometrium (straight arrows) with focal areas of decreased signal intensity (curved arrow) associated with polyps resulting from tamoxifen therapy.
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Figure 27. Endometrial adhesions. Hysterosalpingogram reveals irregular filling defects in the endometrium (arrows) representing adhesions.
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Figure 28. IUD. US image shows a hyperechoic linear structure within the endometrial canal (arrow) representing an IUD.
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Copyright © 2001 by the Radiological Society of North America.
