Experimental & Clinical MRI Research On Adenomyosis

OBJECTIVE: The objective was to investigate the magnetic resonance imaging (MRI) features of adenomyosis with histopathologic correlation and to evaluate the value of MRI in the diagnosis of the disease. MATERIALS AND METHODS: 1 .Thirty six hysterectomized specimens for adenomyosis, thirty ones for leiomyoma and sixteen ones not for uterine corpus disease were iamged within 1.5 hours after their removal. Imaging was performed with a O.5T MR imaging system. All specimens were underwent Inversion Recovery Sequence (IR) Ti-weighted images and Turbo Spin Echo Sequence (TSE) including Ti -weighted (Ti WI) and T2-weighted images. The structure of normal uterine wall and the MRI features of adenomyosis were observed and compared with that of leiomyoma. The findings of MRI were also compared with histopathologic correlation. 2. Forty-six patients of suspicious adenomyosis clinically and twelve normal volunteers were imaged by O.5T MRJ system. Inversion Recovery Sequence (IR) Ti-weighted images and Turbo Spin Echo Sequence (TSE) including Ti -weighted (Ti WI) and T2-weighted images were adopted. The MRI morphology and signal features of normal uterine were analysised as well as the MRI morphology, the signal and contrast enhancement characteristics of adenomyosis. The results also compared with ultra sonography (US) and histopathoiogy. To fifteen cases of all patients with adenomyosis, we compared the MIRI results scanned prior to and post operation. RESULTS: In normal uterus, 2 to 4 layers of the uterine walls with III histological correlation were visible .The typical signal intensity of each layer were seen on each sequence. T2-weighted imags and JR sequence Ti-weighted images showed uterine muscle wall better than TSE sequence Ti -weighted images. The MRI findings of adenomyosis could exhibit correlated pathologic basis. On T2-weighted images, diffuse and local thickening of junctional zone or low signal intensity lesion in outer myometrial layer indicated smooth muscle hyperplasia due to the stimulation of heterotopic endometrial glands time after time. Bright foci observed in lesion correponded to islands of heterotopic endometrial tissue or old hemorrhagic foci. In adenomyosis, the lesion enhancement was lower than that of the ajacent outer myometrium. Comparison of MRI images showed that T2-weighted imags and JR sequence Ti-weighted images were best for studing adenomyosis. MIRJ of vitro uteri has higher distinguishment ratio than that of vivo uterus. The specificity, sensitivity and accuracy of vivo uterus MRI for diagnosis of adenomyosis was 100%, 94.74% and 97.14% respectively according to the diagnostic criteria established by vitro uterus MRI. The effect of MRI for diagnosis of adenomyosis was better than that of US significantly. CONCLUTION: MIRI is able to show normol uterus structure and adenomyosis characteristics clearly. MRI is also able to show uterine myoma clearly and it is useful to differentiate adenomyosis from uterine myoma. MRI has higher sensitivity, specifity and accuracy than that of US significantly. MRI is the most accurate imaging technique for detection and localization of adenomyosis.