Imaging<unk>  can vary widely in the extent and location of its invasion within the uterus. As a result, there are no established pathognomonic features to allow for a definitive diagnosis of<unk>  through non-invasive imaging. Nevertheless, non-invasive imaging techniques such as transvaginal ultrasonography (TVUS) and magnetic resonance imaging (MRI) can both be used to strongly suggest the diagnosis of<unk> , guide treatment options, and monitor response to treatment. Indeed, TVUS and MRI are the only two practical means available to establish a pre-surgical diagnosis. Transvaginal ultrasonography Transvaginal ultrasound of the uterus, showing the endometrium as a hyperechoic (brighter) area in the middle, with linear striations extending upwards from itTransvaginal ultrasonography is a cheap and readily available imaging test that is typically used early during the evaluation of gynecologic symptoms. Ultrasound imaging, like MRI, does not use radiation and is safe for examination of the pelvis and female reproductive organs. Overall, it is estimated that transvaginal ultrasonography has a sensitivity of 79% and specificity of 85% for the detection of<unk> . Common transvaginal ultrasound findings in patients with<unk>  include the following: * globular, enlarged, and/or asymmetric uterus * abnormally dense or especially varied density within the myometrium * myometrial cysts - pockets of fluid within the smooth muscle of the uterus * linear, acoustic shadowing without presence of a uterine fibroid * echogenic linear striations - bright lines or stripes * anterior/posterior wall asymmetry * diffuse spread of small vessels within the myometrium Less common findings: * Lack of contour abnormality * Absence of mass effect * Ill-defined margins between a normal and abnormal myometrium The power Doppler or Doppler ultrasonography function can be used during transvaginal ultrasonography to help differentiate adenomyomas from uterine fibroids. This is because uterine fibroids typically have blood vessels circling the fibroid's capsule. In contrast, adenomyomas are characterized by widespread blood vessels within the lesion. Doppler ultrasonography also serves to differentiate the static fluid within myometrial cysts from flowing blood within vessels. The junction zone (JZ), or a small distinct hormone-dependent region at the endometrial-myometrial interface, may be assessed by three-dimensional transvaginal ultrasound (3D TVUS) and MRI. Features of<unk>  are disruption, thickening, enlargement or invasion of the junctional zone. MRI of a woman's pelvis showing a uterus with<unk>  in the posterior wall. Gross enlargement of the posterior wall is noted, with many foci of hyperintensity. Magnetic resonance imaging Magnetic resonance imaging (MRI) provides slightly better diagnostic capability compared to TVUS, due to the increased ability of MRI to differentiate objectively between different types of soft tissue. This is possible with MRI's higher spatial and contrast resolution. Overall, it is estimated that MRI has a sensitivity of 74% and specificity of 91% for the detection of<unk> . Diagnosis through MRI focuses predominately upon investigating the junctional zone. The uterus will have a thickened junctional zone with darker/diminished signal on both T1 and T2 weighted sequences. Three objective measures of the junctional zone can be used to diagnose<unk> . # A thickness of the junctional zone greater than 8–12 mm. Less than 8 mm is normal. # A junctional zone width being greater than 40% of the width of the myometrium. # Variability in the width of the junctional zone being greater than 5 mm. Interspersed within the thickened, darker signal of the junctional zone, one will often see foci of hyperintensity (bright spots) on the T2 weighted scans representing small cystically dilatated glands or more acute sites of microhemorrhage. MRI is limited by other factors, but not by calcified uterine fibroids (as is ultrasound). In particular, MRI is better able to differentiate<unk>  from multiple small uterine fibroids.
Adenomyosis
Endometrial polyp
Leiomyoma
Endometrial hyperplasia
Cervical pregnancy
Endometriosis
Uterine fibroid
Endometrial intraepithelial neoplasia