1
|
Wang S, Duan H. The role of the junctional zone in the management of adenomyosis with infertility. Front Endocrinol (Lausanne) 2023; 14:1246819. [PMID: 37886646 PMCID: PMC10598341 DOI: 10.3389/fendo.2023.1246819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 09/25/2023] [Indexed: 10/28/2023] Open
Abstract
The junctional zone (JZ) is an important structure in the myometrium that maintains uterine fertility. Changes in the junctional zone are closely related to infertility and adenomyosis (ADS). As an increasing number of young women are affected by ADS, the disease is no longer considered typical of women over 40. With these changes, an increasing number of patients refuse hysterectomy and desire fertility preservation treatment. At the same time, ADS is a crucial factor causing female infertility. Therefore, the treatment of ADS-related infertility and preservation of reproductive function is one of the other major challenges facing clinicians. For these young patients, preserving fertility and even promoting reproduction has become a new challenge. Therefore, we searched and summarized these studies on PubMed and Google Scholar using keywords such as "adenomyosis", "junctional zone", and "infertility" to explore infertility causes, diagnosis, and treatment of ADS patients who wish to preserve their uterus or fertility and become pregnant, focusing on the junctional zone, to obtain a full appreciation of the new perspective on this disease.
Collapse
Affiliation(s)
| | - Hua Duan
- Department of Minimally Invasive Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| |
Collapse
|
2
|
Ren J, Li Y, Liu FS, Liu C, Zhu JX, Nickel MD, Wang XY, Liu XY, Zhao J, He YL, Jin ZY, Xue HD. Comparison of a deep learning-accelerated T2-weighted turbo spin echo sequence and its conventional counterpart for female pelvic MRI: reduced acquisition times and improved image quality. Insights Imaging 2022; 13:193. [PMID: 36512158 DOI: 10.1186/s13244-022-01321-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 10/29/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To investigate the feasibility of a deep learning-accelerated T2-weighted turbo spin echo (TSE) sequence (T2DL) applied to female pelvic MRI, using standard T2-weighted TSE (T2S) as reference. METHODS In total, 24 volunteers and 48 consecutive patients with benign uterine diseases were enrolled. Patients in the menstrual phase were excluded. T2S and T2DL sequences in three planes were performed for each participant. Quantitative image evaluation was conducted by calculating the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). Image geometric distortion was evaluated by measuring the diameters in all three directions of the uterus and lesions. Qualitative image evaluation including overall image quality, artifacts, boundary sharpness of the uterine zonal layers, and lesion conspicuity were assessed by three radiologists using a 5-point Likert scale, with 5 indicating the best quality. Comparative analyses were conducted for the two sequences. RESULTS T2DL resulted in a 62.7% timing reduction (1:54 min for T2DL and 5:06 min for T2S in axial, sagittal, and coronal imaging, respectively). Compared to T2S, T2DL had significantly higher SNR (p ≤ 0.001) and CNR (p ≤ 0.007), and without geometric distortion (p = 0.925-0.981). Inter-observer agreement regarding qualitative evaluation was excellent (Kendall's W > 0.75). T2DL provided superior image quality (all p < 0.001), boundary sharpness of the uterine zonal layers (all p < 0.001), lesion conspicuity (p = 0.002, p < 0.001, and p = 0.021), and fewer artifacts (all p < 0.001) in sagittal, axial, and coronal imaging. CONCLUSIONS Compared with standard TSE, deep learning-accelerated T2-weighted TSE is feasible to reduce acquisition time of female pelvic MRI with significant improvement of image quality.
Collapse
Affiliation(s)
- Jing Ren
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuai Fu Yuan Road, Dongcheng Dist., Beijing, 100730, People's Republic of China
| | - Yuan Li
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Obstetric and Gynecologic Diseases, Beijing, People's Republic of China
| | - Fei-Shi Liu
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuai Fu Yuan Road, Dongcheng Dist., Beijing, 100730, People's Republic of China
| | - Chong Liu
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuai Fu Yuan Road, Dongcheng Dist., Beijing, 100730, People's Republic of China
| | - Jin-Xia Zhu
- MR Collaboration, Siemens Healthineers Ltd., Beijing, People's Republic of China
| | | | - Xiao-Ye Wang
- MR Clinical Marketing, Siemens Healthineers Ltd., Beijing, People's Republic of China
| | - Xin-Yu Liu
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuai Fu Yuan Road, Dongcheng Dist., Beijing, 100730, People's Republic of China
| | - Jia Zhao
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuai Fu Yuan Road, Dongcheng Dist., Beijing, 100730, People's Republic of China
| | - Yong-Lan He
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuai Fu Yuan Road, Dongcheng Dist., Beijing, 100730, People's Republic of China.
| | - Zheng-Yu Jin
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuai Fu Yuan Road, Dongcheng Dist., Beijing, 100730, People's Republic of China.
| | - Hua-Dan Xue
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuai Fu Yuan Road, Dongcheng Dist., Beijing, 100730, People's Republic of China.
| |
Collapse
|
3
|
Timing of Uterine Artery Embolization for Leiomyoma during the Menstrual Cycle. J Vasc Interv Radiol 2021; 32:332-338. [PMID: 33468366 DOI: 10.1016/j.jvir.2020.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/01/2020] [Accepted: 11/15/2020] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To investigate differences in outcomes of uterine artery embolization (UAE) for leiomyoma when performed during different phases of the menstrual cycle. MATERIALS AND METHODS In this single-institution retrospective analysis, 111 premenopausal patients (median [range] age, 44 [33-52] years) undergoing UAE for symptomatic leiomyoma between June 2014 and February 2020 were included. Twenty-one patients underwent UAE in the menstrual phase (the early follicular phase), 27 in the late follicular phase, and 63 in the luteal phase. Baseline characteristics and technical and peri-procedural outcomes were compared among groups. Leiomyoma infarction on contrast-enhanced magnetic resonance imaging 1 week after UAE and 4-month outcomes, including changes in the Uterine Fibroid Symptom and Quality of Life questionnaire scores, the volume reduction rates of the uterus and largest leiomyoma, follicle stimulating hormone values, adverse events, and amenorrhea, were compared among groups. RESULTS A 4-month follow-up was completed for all patients. No significant differences were observed among groups in baseline characteristics or technical and peri-procedural outcomes. There were no significant differences in the multivariate-adjusted 1-week infarction rates of all leiomyoma volumes (P = .161) or multivariate-adjusted 4-month outcomes, including changes in the Uterine Fibroid Symptom and Quality of Life questionnaire symptoms and total scores (P = .864 and P = .798, respectively), the volume reduction rates of the uterus and the largest leiomyoma (P = .865 and P = .965, respectively), and follicle stimulating hormone values (P = .186) among the groups. No significant differences were noted in the 4-month adverse events (P = .260) or amenorrhea (P = .793) among the groups. CONCLUSIONS The present study demonstrated no significant differences in the outcomes of UAE for leiomyoma when performed during different phases of the menstrual cycle.
Collapse
|
4
|
Non-invasive Differentiation of Endometrial Adenocarcinoma from Benign Lesions in the Uterus by Utilization of Amide Proton Transfer-Weighted MRI. Mol Imaging Biol 2020; 23:446-455. [PMID: 33185840 DOI: 10.1007/s11307-020-01565-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/16/2020] [Accepted: 11/05/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE To evaluate the utility of three-dimensional (3D) amide proton transfer-weighted (APTw) imaging for differentiation of endometrial adenocarcinoma and uterine benign lesions. PROCEDURES This prospective study enrolled 22 normal volunteers and 113 patients with suspicious uterine lesions, including endometrial adenocarcinoma, leiomyoma, and adenomyosis. Pelvic APTw MRI was performed on a 3-T MRI scanner with default APTw parameters. Two radiologists blindly evaluated uterine lesion APTw image quality by a 3-point Likert scale and independently measured APTw values on images with excellent to good image quality. Inter-reader agreement was evaluated. The Mann-Whitney U test with Bonferroni correction was used to compare the differences among different types of uterine lesions. A receiver operating characteristic analysis was performed. RESULTS A total of 111 lesions (33 endometrial adenocarcinoma, 26 leiomyoma, and 52 adenomyosis lesions) from 99 patients revealing a majority of good quality with excellent inter-reader agreement were included for the image quality evaluation. APTw values of endometrial adenocarcinoma were 2.9 ± 0.1 %, significantly higher than those of leiomyoma (1.9 ± 0.1 %), adenomyosis (2.2 ± 0.1 %), and normal uterine myometrium (1.9 ± 0.1 %) (all p < 0.0001). The area under the receiver operating characteristic curve for differentiating endometrial adenocarcinoma from leiomyoma, adenomyosis, and myometrium was 0.87, 0.85, and 0.91, respectively. Feasible threshold APTw values of each group were determined as 2.4 %, 2.7 %, and 2.4 % with a sensitivity of 83.3 %, 76.7 %, and 83.3 % and a specificity of 83.3 %, 81.6 %, and 86.4 %, respectively. CONCLUSIONS Malignant endometrial adenocarcinoma had significantly higher APTw values than leiomyoma, adenomyosis, and normal uterine myometrium. Our study adds to the growing body of validation on 3D APTw imaging and uterine lesions.
Collapse
|
5
|
He Y, Li Y, Lin C, Qi Y, Wang X, Zhou H, Yang J, Xiang Y, Xue H, Jin Z. Three‐dimensional turbo‐spin‐echo amide proton transfer‐weighted mri for cervical cancer: A preliminary study. J Magn Reson Imaging 2019; 50:1318-1325. [DOI: 10.1002/jmri.26710] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/20/2019] [Accepted: 02/21/2019] [Indexed: 12/24/2022] Open
Affiliation(s)
- Yong‐Lan He
- Department of Radiology, Peking Union Medical College HospitalPeking Union Medical College and Chinese Academy of Medical Sciences Beijing PR China
| | - Yuan Li
- Department of OB&GYN, Peking Union Medical College HospitalPeking Union Medical College and Chinese Academy of Medical Sciences Beijing PR China
| | - Cheng‐Yu Lin
- Department of Radiology, Peking Union Medical College HospitalPeking Union Medical College and Chinese Academy of Medical Sciences Beijing PR China
| | - Ya‐Fei Qi
- Department of Radiology, Peking Union Medical College HospitalPeking Union Medical College and Chinese Academy of Medical Sciences Beijing PR China
| | | | - Hai‐Long Zhou
- Department of Radiology, Peking Union Medical College HospitalPeking Union Medical College and Chinese Academy of Medical Sciences Beijing PR China
| | - Jun‐Jun Yang
- Department of OB&GYN, Peking Union Medical College HospitalPeking Union Medical College and Chinese Academy of Medical Sciences Beijing PR China
| | - Yang Xiang
- Department of OB&GYN, Peking Union Medical College HospitalPeking Union Medical College and Chinese Academy of Medical Sciences Beijing PR China
| | - Hua‐Dan Xue
- Department of Radiology, Peking Union Medical College HospitalPeking Union Medical College and Chinese Academy of Medical Sciences Beijing PR China
| | - Zheng‐Yu Jin
- Department of Radiology, Peking Union Medical College HospitalPeking Union Medical College and Chinese Academy of Medical Sciences Beijing PR China
| |
Collapse
|