Imaging Adenomyosis 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 adenomyosis 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 adenomyosis, 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 adenomyosis. Common transvaginal ultrasound findings in patients with adenomyosis include the following: * globular, enlarged, and/or asymmetric uterus *<unk> ly 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<unk>  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<unk> ity * Absence of mass effect * Ill-defined margins between<unk>  and<unk>  myometrium The power Doppler or Doppler ultrasonography function can be used during transvaginal ultrasonography to help differentiate adenomyomas from<unk>  fibroids. This is because<unk>  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 adenomyosis are disruption, thickening, enlargement or invasion of the junctional zone. MRI of a woman's pelvis showing a uterus with adenomyosis 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 adenomyosis. 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 adenomyosis. # 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<unk>  fibroids (as is ultrasound). In particular, MRI is better able to differentiate adenomyosis from multiple small<unk>  fibroids.
medical cause of Abnormal uterine bleeding
symptom of Postpartum infections
medical cause of Postpartum bleeding
symptom of Postpartum bleeding
symptoms of Endometriosis
symptom of Endometriosis
symptom of Ectopic pregnancy
symptom of Ovarian cancer