1
|
Hu S, Guo W, Chen S, Wu Z, Zhuang W, Yang J. Factors associated with dysmenorrhoea and menorrhagia improvement in patients with adenomyosis after uterine artery embolisation. J OBSTET GYNAECOL 2024; 44:2372645. [PMID: 38943550 DOI: 10.1080/01443615.2024.2372645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 06/20/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND This study examined the improvement of dysmenorrhoea and menorrhagia after uterine artery embolisation (UAE) in women with symptomatic adenomyosis and identified factors that could predict the improvement of dysmenorrhoea and menorrhagia. METHODS This retrospective study included women with adenomyosis who underwent bilateral UAE between December 2014 and December 2016. The percentage of the volume of the absence of contrast enhancement on T1-weighted images was evaluated 5-7 days after UAE. A receiver operating characteristic (ROC) analysis was used to determine a cut-off point and predict the improvement of dysmenorrhoea and menorrhagia. RESULTS Forty-eight patients were included. At 24 and 36 months after UAE, the improvement rates for dysmenorrhoea and menorrhagia were 60.4% (29/48) and 85.7% (30/35), and the recurrence rates were 19.4% (7/36) and 9.1% (3/33), respectively. Only the percentage of the volume of the absence of contrast enhancement on T1-weighted images was associated with the improvement of dysmenorrhoea (p = 0.001, OR = 1.051; 95% CI: 1.02-1.08) and menorrhagia (p = 0.006, OR = 1.077; 95% CI: 1.021-1.136). When the cut-off value of the ROC analysis was 73.1%, sensitivity, specificity, positive predictive value, and negative predictive value for the improvement of dysmenorrhoea were 58.6%, 94.7%, 94.4%, and 60%, while they were 58.9%, 80%, 100%, 100%, and 45.5% for the improvement of dysmenorrhoea. CONCLUSION Bilateral UAE for symptomatic adenomyosis led to good improvement of dysmenorrhoea and menorrhagia. The percentage of the volume of the absence of contrast enhancement on T1-weighted images of the uterus in postoperative magnetic resonance imaging might be associated with the improvement of dysmenorrhoea and menorrhagia.
Collapse
Affiliation(s)
- Siqi Hu
- Department of Interventional Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
- Department of Nuclear Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Wenbo Guo
- Department of Interventional Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Song Chen
- Department of Interventional Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zhiqiang Wu
- Department of Interventional Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Wenquan Zhuang
- Department of Interventional Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jianyong Yang
- Department of Interventional Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| |
Collapse
|
2
|
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
|
3
|
Moawad G, Fruscalzo A, Youssef Y, Kheil M, Tawil T, Nehme J, Pirtea P, Guani B, Afaneh H, Ayoubi JM, Feki A. Adenomyosis: An Updated Review on Diagnosis and Classification. J Clin Med 2023; 12:4828. [PMID: 37510943 PMCID: PMC10381628 DOI: 10.3390/jcm12144828] [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: 03/08/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
Adenomyosis is a commonly diagnosed benign condition characterized by the presence of ectopic endometrial glands within the underlying myometrium. The most common presenting signs and symptoms are abnormal uterine bleeding, chronic pelvic pain, and infertility. The clinical relevance of this condition is evident in both medical and surgical care. Histopathology and imaging studies are used for the diagnosis and classification of adenomyosis, which are hallmarks of the advancement of our ability to diagnose adenomyosis. Importantly, the diagnosis and classification of adenomyosis lacks standardization due to the nature of imaging techniques, features of adenomyosis, and the clinical spectrum of adenomyosis. We reviewed the literature to summarize the available classification systems for adenomyosis and highlight the different imaging approaches and histologic criteria used in diagnosis. Despite the high prevalence of the disease, there is no clear consensus on one classification system. We provide a review of some of the classification systems available and discuss their strengths and limitations.
Collapse
Affiliation(s)
- Gaby Moawad
- Department of Obstetrics and Gynaecology, The George Washington University Hospital, Washington, DC 20037, USA
| | - Arrigo Fruscalzo
- Department of Obstetrics and Gynecology, HFR-Hòpital Fribourgeois, Chemin des Pensionnats 2-6, 1708 Fribourg, Switzerland
| | - Youssef Youssef
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynaecology-Maimonides Medical Center, Brooklyn, NY 11219, USA
| | - Mira Kheil
- Department of Obstetrics & Gynecology, Henry Ford Health, Detroit, MI 48202, USA
| | - Tala Tawil
- Department of Pathology, Henry Ford Health, Detroit, MI 48202, USA
| | - Jimmy Nehme
- Department of Internal Medicine, Henry Ford Health, Detroit, MI 48202, USA
| | - Paul Pirtea
- Department of Obstetrics and Gynaecology and Reproductive Medicine, Hopital Foch-Faculté de Médecine Paris, 92150 Suresnes, France
| | - Benedetta Guani
- Department of Obstetrics and Gynecology, HFR-Hòpital Fribourgeois, Chemin des Pensionnats 2-6, 1708 Fribourg, Switzerland
| | - Huda Afaneh
- Department of Obstetrics and Gynecology, Women's Health Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Jean Marc Ayoubi
- Department of Obstetrics and Gynaecology and Reproductive Medicine, Hopital Foch-Faculté de Médecine Paris, 92150 Suresnes, France
| | - Anis Feki
- Department of Obstetrics and Gynecology, HFR-Hòpital Fribourgeois, Chemin des Pensionnats 2-6, 1708 Fribourg, Switzerland
| |
Collapse
|
4
|
Cai Y, Sun Y, Xu F, Wu Y, Ren C, Hao X, Gao B, Cao Q. Effects of high-intensity focused ultrasound combined with levonorgestrel-releasing intrauterine system on patients with adenomyosis. Sci Rep 2023; 13:9903. [PMID: 37336924 DOI: 10.1038/s41598-023-37096-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 06/15/2023] [Indexed: 06/21/2023] Open
Abstract
It is very important to treat adenomyosis which may cause infertility, menorrhagia, and dysmenorrhea for women at the reproductive age. High-intensity focused ultrasound (HIFU) is effective in destroying target tumor tissues without damaging the path of the ultrasound beam and surrounding normal tissues. The levonorgestrel-releasing intrauterine system (LN-IUS) is a medical system which is inserted into the uterine to provide medicinal treatment for temporary control of the symptoms caused by adenomyosis. This study was to investigate the effect of HIFU combined with the LN-IUS on adenomyosis. In the HIFU treatment, the parameters of the ultrasound were transmission frequency 0.8 MHz and input power 50-400 W (350 ± 30), and the temperature in the target tissue under these conditions would reach 60-100 °C (85 °C ± 6.3 °C). Size reduction and blood flow signal decrease were used to assess the effect of combined treatment. In this study, 131 patients with adenomyosis treated with HIFU combined with LN-IUS were retrospectively enrolled. The clinical and follow-up data were analyzed. After treatment, the volume of the uterine lesion was significantly decreased with an effective rate of 72.1%, and the adenomyosis blood flow signals were significantly reduced, with an effective rate of 71.3%. At six months, the menstrual cycle was significantly (P < 0.05) decreased from 31.4 ± 3.5 days before treatment to 28.6 ± 1.9 days, the menstrual period was significantly shortened from 7.9 ± 1.2 days before HIFU to 6.5 ± 1.3 days, and the menstrual volume was significantly (P < 0.05) decreased from 100 to 49% ± 13%. The serum hemoglobin significantly (P < 0.05) increased from 90.8 ± 6.2 g/L before treatment to 121.6 ± 10.8 g/L at six months for patients with anemia. Among seventy-two (92.3%) patients who finished the six-month follow-up, sixty-five (90.3%) patients had the dysmenorrhea completely relieved, and the other seven (9.7%) patients had only slight dysmenorrhea which did not affect their daily life. Adverse events occurred in 24 (18.3%) patients without causing severe consequences, including skin burns in two (1.5%) patients, skin swelling in four (3.1%), mild lower abdominal pain and low fever in 15 (11.5%), and subcutaneous induration in three (2.3%). Six months after treatment, no other serious side effects occurred in any patients with follow-up. In conclusions, the use of high-intensity focused ultrasound combined with the levonorgestrel-releasing intrauterine system for the treatment of adenomyosis is safe and effective even though the long-term effect remains to be confirmed.
Collapse
Affiliation(s)
- Yuru Cai
- Department of Obstetrics and Gynecology, Shijiazhuang People's Hospital, 365 South Jianhua Street, Shijiazhuang, 050030, Hebei Province, China
| | - Yanan Sun
- Department of Obstetrics and Gynecology, Shijiazhuang People's Hospital, 365 South Jianhua Street, Shijiazhuang, 050030, Hebei Province, China
| | - Feng Xu
- Department of Obstetrics and Gynecology, Shijiazhuang People's Hospital, 365 South Jianhua Street, Shijiazhuang, 050030, Hebei Province, China
| | - Yunzhe Wu
- Department of Obstetrics and Gynecology, Shijiazhuang People's Hospital, 365 South Jianhua Street, Shijiazhuang, 050030, Hebei Province, China
| | - Chunfeng Ren
- Department of Laboratory Analysis, The First Affiliated Hospital of Zhengzhou University, 1 Longhu Middle Ring Road, Zhengzhou, 450018, Henan Province, China
| | - Xiaohong Hao
- Department of Obstetrics and Gynecology, Shijiazhuang People's Hospital, 365 South Jianhua Street, Shijiazhuang, 050030, Hebei Province, China
| | - Bulang Gao
- Department of Obstetrics and Gynecology, Shijiazhuang People's Hospital, 365 South Jianhua Street, Shijiazhuang, 050030, Hebei Province, China
| | - Qinying Cao
- Department of Obstetrics and Gynecology, Shijiazhuang People's Hospital, 365 South Jianhua Street, Shijiazhuang, 050030, Hebei Province, China.
- Shijiazhuang People's Hospital, 365 South Jianhua Street, Shijiazhuang, 050030, Hebei Province, China.
| |
Collapse
|
5
|
Kumar K, Pajai S, Baidya GR, Majhi K. Utility of Saline Infusion Sonohysterography in Gynecology: A Review Article. Cureus 2023; 15:e35424. [PMID: 36987479 PMCID: PMC10040238 DOI: 10.7759/cureus.35424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 02/22/2023] [Indexed: 03/30/2023] Open
Abstract
This study aimed to describe the role played by saline infusion sonohysterosalpingography (SIS) in the evaluation of uterine lesions. Saline infusion sonohysterosalpingography provides three-dimensional (3D) images with high resolution, which, in turn, gives a good orientation to clinicians and radiologists, in most cases, about the underlying endometrial and tubal pathologies. Saline infusion sonohysterosalpingography is an underused imaging modality that has some advantages over other conventional imaging modalities. It can be used in the diagnosis of gynecological conditions. Saline infusion sonohysterosalpingography gets an edge over other modalities because of its ease of use, cost efficacy, and non-invasive nature while having comparable or even better accuracy than most imaging modalities used in gynecological conditions. Its cost efficacy and excellent pathological characterization make it an imaging modality beneficial for Indian healthcare setups as a whole, and rural healthcare setups in particular where patients cannot afford expensive investigations. This review covers indications and contraindications, imaging technique, drawbacks in imaging, use of SIS in various uterine pathologies, and, in the end, a comparison of SIS with other imaging modalities. Saline infusion sonohysterosalpingography is indicated in most of the prevalent gynecological diseases in India with the reported post-procedural complications being very few. There are a few contraindications as well which should be kept in mind and these are mentioned later. During the procedure, aseptic precautions should be taken. Comparison between imaging modalities will bring out the better modality for a particular case according to the need of the patient.
Collapse
Affiliation(s)
- Kingshuk Kumar
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Sandhya Pajai
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Geeta R Baidya
- Obstetrics and Gynecology, Aashirwad Nursing Home, Ghatsila, IND
| | - Krishnendu Majhi
- Medicine, Employees' State Insurance Dispensary, Jugsalai, Jamshedpur, IND
| |
Collapse
|
6
|
In Search of an Imaging Classification of Adenomyosis: A Role for Elastography? J Clin Med 2022; 12:jcm12010287. [PMID: 36615089 PMCID: PMC9821156 DOI: 10.3390/jcm12010287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 12/31/2022] Open
Abstract
Adenomyosis is a complex and poorly understood gynecological disease. It used to be diagnosed exclusively by histology after hysterectomy; today its diagnosis is carried out increasingly by imaging techniques, including transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI). However, the lack of a consensus on a classification system hampers relating imaging findings with disease severity or with the histopathological features of the disease, making it difficult to properly inform patients and clinicians regarding prognosis and appropriate management, as well as to compare different studies. Capitalizing on our grasp of key features of lesional natural history, here we propose adding elastographic findings into a new imaging classification of adenomyosis, incorporating affected area, pattern, the stiffest value of adenomyotic lesions as well as the neighboring tissues, and other pathologies. We argue that the tissue stiffness as measured by elastography, which has a wider dynamic detection range, quantitates a fundamental biologic property that directs cell function and fate in tissues, and correlates with the extent of lesional fibrosis, a proxy for lesional "age" known to correlate with vascularity and hormonal receptor activity. With this new addition, we believe that the resulting classification system could better inform patients and clinicians regarding prognosis and the most appropriate treatment modality, thus filling a void.
Collapse
|
7
|
Harmsen MJ, Trommelen LM, de Leeuw RA, Tellum T, Juffermans LJM, Griffioen AW, Thomassin-Naggara I, Van den Bosch T, Huirne JAF. Uterine junctional zone and adenomyosis: comparison of MRI, transvaginal ultrasound and histology. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022. [PMID: 36370446 DOI: 10.1002/uog.26117] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 09/27/2022] [Accepted: 10/21/2022] [Indexed: 06/02/2023]
Abstract
The uterine junctional zone is the subendometrial area in the myometrium that contributes to peristalsis and aids in spermatozoa and blastocyst transport. Alterations in the appearance of the junctional zone on transvaginal sonography (TVS) or magnetic resonance imaging (MRI) are associated with adenomyosis. The lack of standardization of description of its appearance and ill-defined boundaries on both histology and imaging hamper understanding of the junctional zone and limit its role in the diagnosis of adenomyosis. The objectives of this review were to investigate the accordance in definition of the junctional zone across different diagnostic approaches and to examine how imaging findings can be linked to histological findings in the context of diagnosis of adenomyosis. A comprehensive literature review was conducted of articles describing the appearance on imaging and the histological structure of the uterine junctional zone. Our review suggests that the junctional zone is distinguished from the middle and outer myometrium by gradual changes in smooth-muscle cell density, extracellular space, connective tissue, water content and vascular properties. However, while the signal intensity from the junctional zone to the middle myometrium changes abruptly on MRI, the histopathological changes are gradual and its border may be difficult or impossible to distinguish on two-dimensional TVS. Moreover, the thickness of the junctional zone measured on MRI is larger than that measured on TVS. Thus, these two imaging modalities reflect this zone differently. Although a thickened junctional zone is often used to diagnose adenomyosis on MRI, the presence of adenomyosis can be described more accurately as interruptions of the junctional zone by endometrial tissue, which leads to direct signs on imaging such as subendometrial lines and buds on two- and three-dimensional TVS or bright foci on MRI. The histopathological criteria for diagnosis are based on enlargement of the uterus with severe adenomyosis, and might not reflect its early stages. Clinicians should be aware that findings on MRI cannot be extrapolated readily to ultrasound. An understanding of this is necessary when investigating the uterine junctional zone as a functional unit and the association between visualization of direct features of adenomyosis in the junctional zone and clinical symptoms. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
Collapse
Affiliation(s)
- M J Harmsen
- Department of Obstetrics & Gynaecology, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - L M Trommelen
- Department of Obstetrics & Gynaecology, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - R A de Leeuw
- Department of Obstetrics & Gynaecology, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - T Tellum
- Department of Gynecology, Oslo University Hospital, Oslo, Norway
| | - L J M Juffermans
- Department of Obstetrics & Gynaecology, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - A W Griffioen
- Angiogenesis Laboratory, Department of Medical Oncology, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - I Thomassin-Naggara
- Department of Diagnostic and Interventional Imaging (IRIS), Sorbonne Université, Assistance Publique Hopitaux de Paris, Paris, France
| | - T Van den Bosch
- Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium
| | - J A F Huirne
- Department of Obstetrics & Gynaecology, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| |
Collapse
|
8
|
Current update on status of saline infusion sonohysterosalpingography. Abdom Radiol (NY) 2022; 47:1435-1447. [PMID: 35112137 DOI: 10.1007/s00261-022-03427-2] [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: 11/09/2021] [Revised: 01/20/2022] [Accepted: 01/24/2022] [Indexed: 11/01/2022]
Abstract
The purpose of this article is to elucidate the current role of saline infusion sonohysterosalpingography (SIS) in evaluation of various uterine pathologies. SIS improves visualization of the endometrium and pathologies related to endometrial cavity, as well as it can simultaneously assess tubal patency. SIS provides high-resolution images, and three-dimensional (3D) reformatted images provide excellent orientation for radiologists as well as the clinicians about the underlying pathologies. This article will discuss imaging technique, indications, pearls, and pitfalls in imaging, diverse disease pathologies, and ultimately compare performance of SIS among other different imaging modalities. SIS as an adjunct imaging modality results in a greater diagnostic yield for diverse uterine pathologies.
Collapse
|
9
|
Shinohara S, Okuda Y, Hirata S, Suzuki K. Adenomyosis as a Potential Risk Factor for Adverse Pregnancy Outcomes: A Multicenter Case-Control Study. TOHOKU J EXP MED 2021; 251:231-239. [PMID: 32684535 DOI: 10.1620/tjem.251.231] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
As the number of women who postpone their first pregnancy until their late 30s or early 40s is increasing, adenomyosis is more frequently encountered by obstetricians. Some studies have reported on the relationship between adenomyosis and pregnancy complications. We aimed to investigate the effect of adenomyosis on pregnancy complications and outcomes and associations between adenomyosis type and pregnancy outcomes. This multicenter retrospective 1:4 case-control study included 61 women with singleton pregnancies diagnosed with adenomyosis. The control group included women with singleton pregnancies without adenomyosis; these women were matched to those with adenomyosis using propensity scores. The incidence of obstetric complications, delivery, and neonatal outcomes were compared. The adenomyosis group (n = 61) had significantly higher incidence of preterm delivery (21.3% vs. 9.4%), hypertensive disorders of pregnancy (13.1% vs. 5.3%), cesarean delivery (46.0% vs. 20.9%), and postpartum hemorrhage (57.3% vs. 36.8%) than the control group (n = 244). Subgroup analysis by the adenomyosis type revealed that the diffuse adenomyosis group (n = 41) was significantly more likely to experience preterm labor (29.3% vs. 7.3%), hypertensive disorders of pregnancy (17.0% vs. 5.5%), severe hypertensive disorders of pregnancy (12.2% vs. 1.8%), preterm premature rupture of membranes (12.2% vs. 2.4%), cesarean delivery (61.3% vs. 18.9%), and postpartum hemorrhage (70.7% vs. 44.5%) than the control group (n = 164). The focal adenomyosis (n = 20) group was not statistically different from the control group (n = 80) with respect to obstetric complications. Women with diffuse adenomyosis require more careful perinatal management than previously thought.
Collapse
Affiliation(s)
- Satoshi Shinohara
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Yamanashi
| | - Yasuhiko Okuda
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Yamanashi
| | - Shuji Hirata
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Yamanashi
| | - Kohta Suzuki
- Department of Health and Psychosocial Medicine, Aichi Medical University School of Medicine
| |
Collapse
|
10
|
Abstract
Uterine adenomyosis can be diagnosed on ultrasonography (US) and magnetic resonance imaging (MRI) with a high degree of accuracy. Adenomyosis is a myometrial process that can appear as diffuse or focal on imaging. Diffuse adenomyosis typically causes uterine enlargement, while focal adenomyosis can mimic other myometrial lesions, such as leiomyomas. Imaging features frequently seen on US include a heterogenous thickened myometrium and myometrial cysts. On MRI, widening of the junctional zone, whether focal or diffuse, and the presence of myometrial cysts, either simple or hemorrhagic, support the diagnosis of adenomyosis. Despite these characteristic imaging appearances, there are several gynecologic pathologies which can mimic adenomyosis and it is important to be vigilant of these when interpreting cross-sectional imaging exams. The decision to evaluate patients with US or MRI is contingent on multiple factors, including availability of the necessary technology and expertise for the latter. However, MRI appears to offer greater specificity and positive predictive value for the diagnosis of adenomyosis.
Collapse
Affiliation(s)
- Aileen O'Shea
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Susanna I Lee
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| |
Collapse
|
11
|
Andersson JK, Pozzi Mucelli R, Epstein E, Stewart EA, Gemzell-Danielsson K. Vaginal bromocriptine for treatment of adenomyosis: Impact on magnetic resonance imaging and transvaginal ultrasound. Eur J Obstet Gynecol Reprod Biol 2020; 254:38-43. [PMID: 32920421 DOI: 10.1016/j.ejogrb.2020.08.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/17/2020] [Accepted: 08/21/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Vaginal bromocriptine significantly reduces heavy menstrual bleeding and pain in women with diffuse adenomyosis. The aim of this pilot study was to evaluate whether imaging findings of adenomyosis, as assessed by transvaginal ultrasound (TVU) and magnetic resonance imaging (MRI) reflect changes induced by the bromocriptine treatment. STUDY DESIGN Eighteen women, aged 35-50, with heavy menstrual bleeding reporting Pictorial Blood Loss Assessment Chart (PBLAC) scores >100 and diffuse adenomyosis according to both MRI and TVU were included. The subjects underwent treatment with vaginal bromocriptine for 6 months. MRI and TVU were performed at baseline and after 6 months of medication. RESULTS Mean age of the participants was 44.8 years, 77.8 % reported PBLAC scores > 250 and 66.7 % reported moderate to severe pain during menstruation at baseline. As compared to baseline, TVU revealed a thinner maximal Junctional Zone (JZmax) (8.5 mm [5.2-14] vs 7.9 mm [5-11.2], p = 0.02) at 6 months. Asymmetric wall thickening was seen in 13 (72 %) at baseline, and in 6 (33 %) women at 6 months, p = 0.02. No significant changes were seen in irregular endometrial-myometrial border, presence of fan-shaped shadowing, cystic changes, striations, hyperechogenic islands or lesion extension. MRI showed no significant difference in JZmax (16.0 mm[12.1-27.7] vs 15.5 mm [9.5-25.8], p = 0.81), JZdifference (9.5 mm[4.8-21.6] vs 8.4[3.8-19.5], p = 1) or Ratio JZ/myometrium (0.6 [0.5-0.8] vs. 0.6[0.4-0.8], p = 0.9) at baseline vs 6 month. Cystic lesions in the JZ were found in 9 women (50 %) before, and in 5 women (28 %) at 6 months, p = 0.13. CONCLUSION TVU showed a significant decrease in JZ max and a reduced number of women with asymmetric myometrial wall thickness. The changes seen in this small pilot study may indicate that vaginal bromocriptine have an impact on adenomyosis that is reflected in radiological appearance.
Collapse
Affiliation(s)
- Johanna K Andersson
- Department of Women´s and Children´s Health, Karolinska Institutet and Liljeholmens gynecological clinic, Stockholm, Sweden.
| | - Raffaella Pozzi Mucelli
- Department of Abdominal Radiology, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Elisabeth Epstein
- Department of Clinical Science and Education Karolinska Institutet, and Department of Obstetrics and Gynecology, Sodersjukhuset, Stockholm, Sweden
| | - Elizabeth A Stewart
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Kristina Gemzell-Danielsson
- Department of Women´s and Children´s Health, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
12
|
Kim M, Kim YS, Choi JI, Kim JM, Lee HH, Kim TH. G protein-coupled estrogen receptor 1 expression in normal myometrium, leiomyoma, and adenomyosis tissues of premenopausal women. Gynecol Endocrinol 2020; 36:599-604. [PMID: 32321334 DOI: 10.1080/09513590.2020.1751108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
To verify the different expression of G protein-coupled estrogen receptor 1 (GPER1) among normal uterine, leiomyoma, and adenomyosis tissues. Normal uterine, leiomyoma, and adenomyosis tissue samples were obtained from women aged 35-52 years from a tertiary university hospital. The tissue samples were subjected to immunohistochemical, Western blot, and reverse-transcription polymerase chain reaction (RT-PCR) analyses of GPER1. GPER1 protein expression was confirmed in the tissues by immunohistochemical and Western blot analyses and compared with GPER1 mRNA levels using RT-PCR. GPER1 was detected in the tissue samples of leiomyoma and adenomyosis, which are estrogen-dependent diseases. GPER1 expression was similar between normal uterine and leiomyoma tissues but was reduced in adenomyosis tissue. The level of phosphorylated extracellular signal-regulated kinases 1/2 was lower and higher in leiomyoma and adenomyosis tissues, respectively, than in normal tissue, but the differences among the groups were not statistically significant. Our immunohistochemical, Western blot, and RT-PCR results suggest that GPER1 expression is involved in cell proliferation in leiomyoma and in cell invasion and migration in adenomyosis. Functional studies of GPER1 involving larger sample sizes should be performed to confirm the adenomyosis and leiomyoma disease mechanisms and eventually to develop new therapeutic interventions for these diseases.
Collapse
Affiliation(s)
- Mijin Kim
- Department of Interdisciplinary Program in Biomedical Science, Soonchunhyang University Graduate School, Asan, Republic of Korea
| | - Yeon-Suk Kim
- Department of Interdisciplinary Program in Biomedical Science, Soonchunhyang University Graduate School, Asan, Republic of Korea
| | - Jeong In Choi
- Department of Obstetrics and Gynecology, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Jun-Mo Kim
- Department of Urology, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Hae-Hyeog Lee
- Department of Obstetrics and Gynecology, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Tae-Hee Kim
- Department of Obstetrics and Gynecology, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| |
Collapse
|
13
|
Abu Hashim H, Elaraby S, Fouda AA, Rakhawy ME. The prevalence of adenomyosis in an infertile population: a cross-sectional study. Reprod Biomed Online 2020; 40:842-850. [PMID: 32376315 DOI: 10.1016/j.rbmo.2020.02.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 02/10/2020] [Accepted: 02/17/2020] [Indexed: 12/12/2022]
Abstract
RESEARCH QUESTION Adenomyosis has been reported in a high proportion (24.4%) of infertile women, but this may be over-representative. What is the exact prevalence of adenomyosis in an infertility clinic population? DESIGN In this cross-sectional study, 320 infertile women ≤41 years of age attending the infertility clinic of a university teaching hospital were screened by two-dimensional transvaginal ultrasound (2D-TVS) to look for the sonographic markers of adenomyosis, with subsequent magnetic resonance imaging (MRI) if suspected. Additionally, the adenomyosis subtype (I-IV) was determined from MRI geography (Kishi classification). Comparisons between women with and without adenomyosis were carried out. RESULTS Adenomyosis was found by 2D-TVS in 24 cases (7.5%) and confirmed by MRI in 21 (6.6%). The mean age of the group was 29.2 ± 4.7 years. The most frequently observed sonographic finding (58.3% of cases) was asymmetrical myometrial thickening. The majority of MRI-confirmed cases (85.7%) had diffuse adenomyosis. A significantly higher prevalence was found in women ≥40 compared with women <40 years old (40.0% versus 4.9%, respectively; P < 0.0001). Adenomyotic women had significantly higher mean age (32.7 ± 3.0 versus 28.6 ± 4.4 years; P < 0.00001), body mass index (31.3 ± 2.7 versus 28.7 ± 3.3 kg/m2; P < 0.0001), suffered more dysmenorrhoea (38% versus 17%; P = 0.02) and had more ovarian endometriomas (19% versus 6%; P = 0.03) than those without adenomyosis. CONCLUSION The observed prevalence of adenomyosis detected de novo by 2D-TVS in a population of young infertile women (7.5%) should alert gynaecologists and ultrasonographers to look for the features of adenomyosis when scanning such patients.
Collapse
Affiliation(s)
- Hatem Abu Hashim
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mansoura University, Mansoura Dakahlia 35516, Egypt.
| | - Solafa Elaraby
- Department of Obstetrics and Gynecology, Mansoura General Hospital, Mansoura Dakahlia 35511, Egypt
| | - Ashraf A Fouda
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mansoura University, Mansoura Dakahlia 35516, Egypt
| | - Mohamed El Rakhawy
- Department of Diagnostic Radiology, Faculty of Medicine, Mansoura University, Mansoura Dakahlia 35516, Egypt
| |
Collapse
|
14
|
Tellum T, Matic GV, Dormagen JB, Nygaard S, Viktil E, Qvigstad E, Lieng M. Diagnosing adenomyosis with MRI: a prospective study revisiting the junctional zone thickness cutoff of 12 mm as a diagnostic marker. Eur Radiol 2019; 29:6971-6981. [DOI: 10.1007/s00330-019-06308-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 05/05/2019] [Accepted: 06/05/2019] [Indexed: 12/20/2022]
|
15
|
Kadıyoran C. Adenomyosis and Subcutaneous Fatty Tissue Thickness Relationship. JOURNAL OF MEDICAL SCIENCES AND HEALTH 2019. [DOI: 10.46347/jmsh.2019.v05i01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
16
|
Zheng R, Zeng D, Wan TT, Guo WB, Guo Y, Liu MJ. Predisposing factors for predicting the therapeutic response of adenomyosis after uterine artery embolization: serum CA125 levels and accompanying endometriosis. ACTA ACUST UNITED AC 2019; 24:364-371. [PMID: 30373724 DOI: 10.5152/dir.2018.17479] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to identify predisposing factors that could help predict the therapeutic response of adenomyosis after uterine artery embolization (UAE). METHODS This was a retrospective, single-center study of patients admitted to the hospital for adenomyosis between 2013 and 2015. Sixty-eight patients with adenomyosis who underwent UAE with tris-acryl gelatin microspheres were divided into two groups based on their therapeutic response (complete or incomplete necrosis of lesions), and pre- and postprocedural pelvic magnetic resonance imaging (MRI) data. Patients were followed up for 12 months after UAE. Improvements in dysmenorrhea and menorrhagia were evaluated based on the symptom relief criteria. Improvement rates in both groups were analyzed and compared. Multivariate logistic regression analysis was used to identify the predisposing factors from retrospectively gathered baseline data that might affect the therapeutic response, including MRI features, clinical symptoms, biochemical index, and accompanying diseases of adenomyosis. Then, a prognostic model was established, and the receiver operating characteristic (ROC) curve of identified factors was drawn to determine their predictive value. RESULTS Following UAE, 46 patients (67.6%) showed complete necrosis, while 22 patients (32.4%) showed incomplete necrosis. At 12-month follow-up, dysmenorrhea symptom improvement was seen in 94.7% of complete necrosis and 50% of incomplete necrosis group (P < 0.001); menorrhagia symptom improvement was seen in 96.2% of complete necrosis and 57.1% of incomplete necrosis groups (P = 0.004). Multivariate logistic regression analysis determined serum cancer antigen 125 (CA125) levels (odds ratio [OR], 1.006; 95% confidence interval [CI], 1.002-1.010; P = 0.005) and accompanying endometriosis (OR, 6.869; 95% CI, 1.881-25.016; P = 0.004) as predisposing factors. The areas under the ROC curve of CA125, endometriosis, and these two indicators combined were 0.785, 0.708, and 0.845, which corresponded to sensitivities of 95.5%, 66.7%, and 68.2% and specificities of 52.2%, 80.0%, and 87.0% at optimal cutoff values, respectively. CONCLUSION Symptom relief of dysmenorrhea and menorrhagia for patients with complete necrosis was significantly better than that for patients with incomplete necrosis. Serum CA125 levels and accompanying endometriosis can effectively distinguish complete necrosis from incomplete necrosis.
Collapse
Affiliation(s)
- Rui Zheng
- Department of Interventional Radiology The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Dan Zeng
- Department of Radiology, Huangpu Division, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ting-Ting Wan
- Department of Interventional Radiology The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wen-Bo Guo
- Department of Interventional Radiology The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yan Guo
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ming-Juan Liu
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
17
|
Bazot M, Daraï E. Role of transvaginal sonography and magnetic resonance imaging in the diagnosis of uterine adenomyosis. Fertil Steril 2018; 109:389-397. [DOI: 10.1016/j.fertnstert.2018.01.024] [Citation(s) in RCA: 124] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 01/15/2018] [Accepted: 01/18/2018] [Indexed: 11/28/2022]
|
18
|
Hysterectomy-corrected rates of endometrial cancer among women younger than age 50 in the United States. Cancer Causes Control 2018; 29:427-433. [DOI: 10.1007/s10552-018-1018-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 02/23/2018] [Indexed: 02/02/2023]
|
19
|
Tamura H, Kishi H, Kitade M, Asai-Sato M, Tanaka A, Murakami T, Minegishi T, Sugino N. Complications and outcomes of pregnant women with adenomyosis in Japan. Reprod Med Biol 2017; 16:330-336. [PMID: 29259486 PMCID: PMC5715891 DOI: 10.1002/rmb2.12050] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 07/09/2017] [Indexed: 11/09/2022] Open
Abstract
Purpose To investigate the impact of adenomyosis on the complications and outcomes of pregnancy in Japan. Methods We carried out a multicenter retrospective questionnaire survey. A questionnaire regarding pregnancy complications and the outcomes of pregnancy was sent to 725 facilities. Results Data were obtained on the cases of 272 pregnant women with adenomyosis from 65 facilities. The complications of pregnancy included miscarriage before 12 weeks of pregnancy (14.8%), miscarriage after 12 weeks of pregnancy (9.9%), preterm delivery (24.4%), fetal growth restriction (11.8%), pregnancy‐induced hypertension (9.9%), intrauterine infection (7.3%), and cervical incompetency (5.3%). The rates of pregnancy complications in the three groups classified according to pretreatment for adenomyosis (no pretreatment, medication, surgery) did not differ to a statistically significant extent. The rates of miscarriage (>12 weeks) and cervical incompetency increased according to the size of the adenomyosis. The rates of pregnancy‐induced hypertension and uterine infection in patients with diffuse‐type adenomyosis were higher than that in patients with focal‐type adenomyosis. Conclusions Our results show that the increased size and diffuse type of adenomyosis are associated with adverse pregnancy outcome. We should be aware of the higher incidence of pregnancy‐induced hypertension and uterine infection in patients with diffuse‐type adenomyosis.
Collapse
Affiliation(s)
- Hiroshi Tamura
- Department of Obstetrics and Gynecology Yamaguchi University Graduate School of Medicine Ube Japan
| | - Hiroshi Kishi
- Department of Obstetrics and Gynecology Gunma University Graduate School of Medicine Maebashi Japan
| | - Mari Kitade
- Department of Obstetrics and Gynecology Juntendo University School of Medicine Tokyo Japan
| | - Mikiko Asai-Sato
- Department of Obstetrics and Gynecology Yokohama City University Hospital Yokohama Japan
| | - Atsushi Tanaka
- Saint Mother Obstetrics and Gynecology Clinic Institute for ART Fukuoka Japan
| | - Takashi Murakami
- Department of Obstetrics and Gynecology Shiga University of Medical Science Otsu Japan
| | - Takashi Minegishi
- Department of Obstetrics and Gynecology Gunma University Graduate School of Medicine Maebashi Japan
| | - Norihiro Sugino
- Department of Obstetrics and Gynecology Yamaguchi University Graduate School of Medicine Ube Japan
| |
Collapse
|
20
|
Tamura H, Kishi H, Kitade M, Asai-Sato M, Tanaka A, Murakami T, Minegishi T, Sugino N. Clinical outcomes of infertility treatment for women with adenomyosis in Japan. Reprod Med Biol 2017; 16:276-282. [PMID: 29259478 PMCID: PMC5715885 DOI: 10.1002/rmb2.12036] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 04/15/2017] [Indexed: 01/11/2023] Open
Abstract
Aim A multicenter, retrospective survey was conducted in order to investigate the current clinical status of adenomyosis in Japan. Methods The questionnaires covered the management of infertile women with adenomyosis and the outcomes of infertility treatment in women with adenomyosis. The questionnaires were sent to 1149 facilities in Japan. Results The data were obtained on 535 infertile women with adenomyosis from 190 facilities. Regarding management, infertility treatment was performed without pretreatment for adenomyosis in 37 facilities, after medication in eight facilities, and after an operation in four facilities. Management policies were not established in 106 facilities. Regarding outcomes, the pregnancy rate was 41.7% and the abortion rate was 29.8%. Eighty‐five patients received medication and 89 patients underwent surgery as a pretreatment before infertility treatment, while 361 patients had no pretreatment. In relation to the type of adenomyosis, 162 patients had the focal type and 336 patients had the diffuse type. The pregnancy rate and abortion rate were not affected by pretreatment or the type of adenomyosis. Conclusion The management policy for infertile women with adenomyosis has not been established. The pregnancy rate of infertility treatment is about 40%. There were no data to suggest that medication or surgery as a pretreatment for adenomyosis increased the pregnancy rate in infertile women.
Collapse
Affiliation(s)
- Hiroshi Tamura
- Department of Obstetrics and Gynecology Yamaguchi University Graduate School of Medicine Ube Japan
| | - Hiroshi Kishi
- Department of Obstetrics and Gynecology Gunma University Graduate School of Medicine Maebashi Japan
| | - Mari Kitade
- Department of Obstetrics and Gynecology Juntendo University School of Medicine Tokyo Japan
| | - Mikiko Asai-Sato
- Department of Obstetrics and Gynecology Yokohama City University Hospital Yokohama Japan
| | - Atsushi Tanaka
- Saint Mother Obstetrics and Gynecology Clinic Institute for ART Fukuoka Japan
| | - Takashi Murakami
- Department of Obstetrics and Gynecology Shiga University of Medical Science Otsu Japan
| | - Takashi Minegishi
- Department of Obstetrics and Gynecology Gunma University Graduate School of Medicine Maebashi Japan
| | - Norihiro Sugino
- Department of Obstetrics and Gynecology Yamaguchi University Graduate School of Medicine Ube Japan
| |
Collapse
|
21
|
Radzinsky VE, Khamoshina MB, Nosenko EN, Dukhin AO, Sojunov MA, Orazmuradov AA, Lebedeva MG, Orazov MR. Treatment strategies for pelvic pain associated with adenomyosis. Gynecol Endocrinol 2016; 32:19-22. [PMID: 27759444 DOI: 10.1080/09513590.2016.1232673] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To observe the effects of levonorgestrel-releasing intrauterine system (LNG-IUS) in treatment of chronic pelvic pain associated with adenomyosis (AM) and in prevention of its recurrence. METHODS A prospective continuing study including 180 patients with chronic pelvic pain associated with AM who received insertion of LNG-IUS who were divided into three groups depending on the pain severity. The visual analog scale (VAS) was used for pain assessment before and during the treatment and transvaginal ultrasonic measurement of the uterine size, while various side effects, were observed and recorded. RESULTS After placement of LNG-IUS, scores of pain and ratio of severe pelvic pain decreased significantly compared with baselines (p < 0.01), the scores of VAS were 9.0 ± 0.8, 6.5 ± 2.8, 4.3 ± 1.8, 3.3 ± 2.2, 2.2 ± 2.1, 2.2 ± 1.8, 1.4 ± 1.6 and 1.3 ± 1.3 at 0, 3, 6 and 12 months, respectively. During 12 months after placement of LNG-IUS, scores of pain had improved significantly compared with preceding period (p < 0.01). We found no universal dependent factors predicting improvement of pain, which was neither relevant with simultaneous changes of menstruation patterns nor with adverse effects (p > 0.005). CONCLUSION The obtained results allowed to confirm the possibility of using LNG-IUS in the treatment of pelvic pain syndrome associated with AM, particularly with mild and moderately severe pelvic pain syndrome. This is a cost effective, reversible and long-term treatment for women with pelvic pain associated with AM, which reduces the need for surgical interventions.
Collapse
Affiliation(s)
- V E Radzinsky
- a Department of Obstetrics and Gynecology with a Course in Perinatology , Faculty of Medicine, Peoples' Friendship University of Russia , Moscow , Russia
| | - M B Khamoshina
- a Department of Obstetrics and Gynecology with a Course in Perinatology , Faculty of Medicine, Peoples' Friendship University of Russia , Moscow , Russia
| | - E N Nosenko
- a Department of Obstetrics and Gynecology with a Course in Perinatology , Faculty of Medicine, Peoples' Friendship University of Russia , Moscow , Russia
| | - A O Dukhin
- a Department of Obstetrics and Gynecology with a Course in Perinatology , Faculty of Medicine, Peoples' Friendship University of Russia , Moscow , Russia
| | - M A Sojunov
- a Department of Obstetrics and Gynecology with a Course in Perinatology , Faculty of Medicine, Peoples' Friendship University of Russia , Moscow , Russia
| | - A A Orazmuradov
- a Department of Obstetrics and Gynecology with a Course in Perinatology , Faculty of Medicine, Peoples' Friendship University of Russia , Moscow , Russia
| | - M G Lebedeva
- a Department of Obstetrics and Gynecology with a Course in Perinatology , Faculty of Medicine, Peoples' Friendship University of Russia , Moscow , Russia
| | - M R Orazov
- a Department of Obstetrics and Gynecology with a Course in Perinatology , Faculty of Medicine, Peoples' Friendship University of Russia , Moscow , Russia
| |
Collapse
|
22
|
Jayaram R, Subbarayan K, Mithraprabhu S, Govindarajan M. Heavy menstrual bleeding and dysmenorrhea are improved by Magnetic Resonance Guided Focused Ultrasound Surgery (MRgFUS) of adenomyosis. FERTILITY RESEARCH AND PRACTICE 2016; 2:8. [PMID: 28620535 PMCID: PMC5424318 DOI: 10.1186/s40738-016-0021-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 04/11/2016] [Indexed: 11/28/2022]
Abstract
Background To assess reduction in heavy menstrual bleeding and dysmenorrhea following MRI guided Focused Ultrasound Surgery (MRgFUS) of focal and diffuse adenomyosis up to 12 months post-treatment a retrospective cohort study was done at a tertiary care academic medical center for obstetrics, gynecology and infertility. Methods MRgFUS for adenomyosis uterus was done for thirty-seven patients presenting with symptoms of heavy menstrual bleeding and dysmenorrhea with MRI-suspected adenomyosis. The main outcome measure, was reduction in heavy menstrual bleeding, dysmenorrhea and Symptom Severity Scoring (SSS) over a 3, 6 and 12 month period. Secondary outcome was evidence of fertility preservation post procedure. D’Agostino & Pearson omnibus normality test, one-way Ananova, Pearson’s correlation coefficient analysis was performed on the data. Statistical significances, p-value and r-value were determined. Results Out of 37 patients who were treated by MRgFUS, 26 had sufficient follow-up to be included in the analysis. SSS calculated at 3, 6 and 12 months was significantly over the baseline. Both heavy menstrual bleeding and dysmenorrhea, which were assessed separately, were found to significantly improve over time with a positive correlation between the two. No other intervention was required. Conclusion MRgFUS provides immediate and sustained relief for patients with focal and diffuse adenomyosis. Electronic supplementary material The online version of this article (doi:10.1186/s40738-016-0021-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Ramya Jayaram
- Department of Obstetrics and Gynecology, Womens Center, 146B Mettupalayam Road, Coimbatore, 641043 Tamil Nadu India.,Department of Radiology, Womens Center, 146B Mettupalayam Road, Coimbatore, 641043 Tamil Nadu India
| | - Kalpana Subbarayan
- Department of Radiology, Womens Center, 146B Mettupalayam Road, Coimbatore, 641043 Tamil Nadu India
| | - Sridurga Mithraprabhu
- Department of Obstetrics and Gynecology, Womens Center, 146B Mettupalayam Road, Coimbatore, 641043 Tamil Nadu India.,Australian Centre for Blood Diseases, Alfred Hospital/Monash University, Melbourne, Victoria 3800 Australia
| | - Mirudhubashini Govindarajan
- Department of Obstetrics and Gynecology, Womens Center, 146B Mettupalayam Road, Coimbatore, 641043 Tamil Nadu India.,Department of Radiology, Womens Center, 146B Mettupalayam Road, Coimbatore, 641043 Tamil Nadu India
| |
Collapse
|
23
|
Cox M, Gould SW, Podberesky DJ, Epelman M. Magnetic resonance imaging of acquired disorders of the pediatric female pelvis other than neoplasm. Pediatr Radiol 2016; 46:806-17. [PMID: 27229499 DOI: 10.1007/s00247-016-3595-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 01/29/2016] [Accepted: 02/19/2016] [Indexed: 02/04/2023]
Abstract
Transabdominal US remains the primary screening imaging modality of the pediatric female pelvis. However, MRI has become an invaluable adjunct to US in recent years. MRI offers superb soft-tissue contrast resolution that allows for detailed evaluation, particularly of the ovaries and their associated pathology. MRI can yield diagnostic information that is similar to or even better than that of US, especially in nonsexually active girls in whom transvaginal US would be contraindicated. MRI is generally a second-line examination and is preferred over CT because it does not involve the use of ionizing radiation. MRI might be underutilized in this population, particularly in differentiating surgical from nonsurgical conditions. This article reviews the relevant anatomy and discusses imaging of acquired conditions that involve the pediatric female genital tract, illustrating associated pathology with case examples.
Collapse
Affiliation(s)
- Mougnyan Cox
- Department of Medical Imaging, Nemours Children's Health System/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Sharon W Gould
- Department of Medical Imaging, Nemours Children's Health System/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Daniel J Podberesky
- Department of Medical Imaging/Radiology, Nemours Children's Health System/Nemours Children's Hospital, 13535 Nemours Parkway, Orlando, FL, 32827, USA
| | - Monica Epelman
- Department of Medical Imaging/Radiology, Nemours Children's Health System/Nemours Children's Hospital, 13535 Nemours Parkway, Orlando, FL, 32827, USA.
| |
Collapse
|
24
|
Augmented reality in gynecologic surgery: evaluation of potential benefits for myomectomy in an experimental uterine model. Surg Endosc 2016; 31:456-461. [DOI: 10.1007/s00464-016-4932-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 04/09/2016] [Indexed: 11/25/2022]
|
25
|
Nusair B, Al-Gudah M, Chodankar R, Abdelazim IA, Faza MA. Uterine Fibroid Mapping. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2016. [DOI: 10.1007/s13669-016-0154-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
|
26
|
Sofic A, Husic-Selimovic A, Carovac A, Jahic E, Smailbegovic V, Kupusovic J. The Significance of MRI Evaluation of the Uterine Junctional Zone in the Early Diagnosis of Adenomyosis. Acta Inform Med 2016; 24:103-6. [PMID: 27147800 PMCID: PMC4851503 DOI: 10.5455/aim.2016.24.103-106] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 03/15/2016] [Indexed: 11/23/2022] Open
Abstract
Goal: The aim of the study is to define the MRI appearance of disorder in the Junctional zone (JZ) in women with adenomyosis compared to those without it, given the importance of the JZ in the regulation of various reproductive events. Materials and methods: This was a prospective, comparative and open study. Patients with adenomyosis have been sorted in target group, n = 82, while the control group consisted of patients without adenomyosis, n = 82. All patients, from both groups have undergone a magnetic resonance imaging of the pelvis. Using a software tool for measurement, the thickness of the JZ was measured in T2w sag sequences in all patients from both groups (target and control) n = 164. Patients in the target group type adenomyosis were assessed and categorized either as: diffuse, focal, or Adenomyoma and the results were compared. The presence of endometriosis and myomas in both groups was evaluated and its coexistence with adenomyosis was analyzed as well. Results: Of the 82 patients in the target group, 81.7% of the patients had diffuse adenomyosis, while 18.3% had focal type with statistically significant difference (p <0.05). The results of the Mann-Whitney U test showed that p <0.05, implying that there is a statistically significant difference in the thickness of the JZ between the control and target group, therefore patients from the target group with adenomyosis had a statistically significantly thicker junctional zone than the patients in the control group. The JZ in the target group was on average M = 14,3mm, SD = 1.3mm, while the thickness of JZ in the control group without adenomyosis was M = 5,6mm, SD = 1,3. Chi-square shows that p <0.05, implying that there is a statistically significant difference in the number of patients with myomas between the two groups, where the myomas significantly over-represented in the target group with 32,9 % vs.6 %). Conclusion: MRI is the method of choice for imaging and evaluation of JZ as an important diagnostic marker in the diagnosis of adenomyosis. It is important to recognize this condition as early as possible and distinguish it from other pathologies in order for timely and appropriate treatment.
Collapse
Affiliation(s)
- Amela Sofic
- Clinic of Radiology, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Azra Husic-Selimovic
- Institute of Gastroenterology and Hepatology, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Aladin Carovac
- Clinic of Radiology, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Elma Jahic
- Clinic of Radiology, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Velda Smailbegovic
- Clinic of Oncology and Radiotherapy University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Jana Kupusovic
- Institute of Gastroenterology and Hepatology, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| |
Collapse
|
27
|
Kido A, Fujimoto K, Matsubara N, Kataoka M, Konishi I, Togashi K. A Layer of Decreased Apparent Diffusion Coefficient at the Endometrial-Myometrial Junction in Uterine Adenomyosis. Magn Reson Med Sci 2015; 15:220-6. [PMID: 26607810 PMCID: PMC5600059 DOI: 10.2463/mrms.mp.2015-0084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To assess the detectability of a low-signal-intensity line within adenomyosis lesions adjacent to the endometrium on apparent diffusion coefficient (ADC) maps, and to establish correlations between these lesions and their possible causes, and more particularly the hormonal changes and magnetic resonance (MR) factors. MATERIALS AND METHODS MR images were obtained from 110 patients with adenomyosis (age 30-57 y.o.) using 3.0 T or 1.5 T MR units. Recognition of the low-signal-intensity line on ADC map was scored using confidence level. The correlation between recognition of the line and the following factors were examined: magnetic field strength, age group, menstrual cycle phases, history of delivery, and hormonal treatments. Presence of the structure corresponding to the low-signal-intensity line on ADC map was evaluated pathologically in the cases that underwent surgery. RESULTS The low-signal-intensity line visible on ADC map was recognized in 55/110 patients. The visibility of the line was not significantly related to hormonal status, age, history of delivery, or magnetic resonance imaging (MRI) magnet strength. There were no corresponding pathological structures. CONCLUSION One half of the adenomyosis patients showed discrepant appearances in T2-weighted (T2WI) vs. ADC map, but no significant relationship with hormonal changes was found in this study. This result may suggest that the low-signal-intensity line within the junctional zone may be related to a functional phenomenon.
Collapse
Affiliation(s)
- Aki Kido
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University
| | | | | | | | | | | |
Collapse
|
28
|
Kdous M, Ferchiou M, Zhioua F. [Uterine adenomyosis, clinical and therapeutic study: about 87 cases]. Pan Afr Med J 2015; 22:73. [PMID: 26834926 PMCID: PMC4725665 DOI: 10.11604/pamj.2015.22.73.7462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 07/31/2015] [Indexed: 11/11/2022] Open
Abstract
Le but de notre étude est l'analyse des différents aspects épidémiologiques, cliniques, paracliniques et thérapeutiques de l'adénomyose. Il s'agit d'une étude rétrospective sur 87 patientes ayant bénéficié d'une hystérectomie pour des raisons diverses (hors prolapsus) entre le 1er janvier 2000 et 31 décembre 2006 et dont l’étude histologique de la pièce opératoire a révélé la présence d'adénomyose. 586 hystérectomies (hors prolapsus) ont été réalisées pendant la même période d’étude, soit une fréquence de l'adénomyose sur pièce opératoire de 14.85%. L'age moyen de nos patientes est de 43.97 ans (extrêmes: 26-64 ans). 29.88% d'entres-elles sont ménopausées et 41.37% avaient des antécédents de traumatisme utérin. La symptomatologie a été dominée par les ménometrorragies (82.77%) et les douleurs pelviennes (71.22%). Le diagnostic préopératoire a été suspecté sur les données de l'hystéroscopie dans 63.22% des cas, de l'hystérographie dans 58.46% des cas et de l’échographie transvaginale dans 40.5% des cas. Une chirurgie radicale a été indiquée de première intention dans 57 cas, après échec du traitement médical dans 16 cas et après échec d'une réduction endométriale dans 14 cas. L'analyse histologique des pièces d'hystérectomie trouve des myomes associés dans 32.18% des cas, une hyperplasie de l'endomètre dans 13.79%, des polypes dans 5.74% et une atrophie de l'endomètre dans 3.44%. L'adénomyose, maladie énigmatique, échappe toujours à une stratégie thérapeutique bien codifiée, et demeure étroitement liée à l'hystérectomie. Son dépistage chez des femmes de plus en plus jeunes et à des stades moins avancés pourrait éviter l’évolution systématique vers les traitements radicaux.
Collapse
Affiliation(s)
- Moez Kdous
- Service de Gynécologie Obstétrique et de Médecine de la Reproduction, Hôpital Aziza Othmana de Tunis, La Kasbah, 1008 Tunis, Tunisie
| | - Monia Ferchiou
- Service de Gynécologie Obstétrique et de Médecine de la Reproduction, Hôpital Aziza Othmana de Tunis, La Kasbah, 1008 Tunis, Tunisie
| | - Fethi Zhioua
- Service de Gynécologie Obstétrique et de Médecine de la Reproduction, Hôpital Aziza Othmana de Tunis, La Kasbah, 1008 Tunis, Tunisie
| |
Collapse
|
29
|
Leursen G, Gardner CS, Sagebiel T, Patnana M, de CastroFaria S, Devine CE, Bhosale PR. Magnetic Resonance Imaging of Benign and Malignant Uterine Neoplasms. Semin Ultrasound CT MR 2015; 36:348-60. [PMID: 26296485 DOI: 10.1053/j.sult.2015.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Benign and malignant uterine masses can be seen in the women. Some of these are asymptomatic and incidentally discovered, whereas others can be symptomatic. With the soft tissue contrast resolution magnetic resonance imaging can render a definitive diagnosis, which can further help streamline patient management. In this article we show magnetic resonance imaging examples of benign and malignant masses of the uterus and their treatment strategies.
Collapse
Affiliation(s)
- Gustavo Leursen
- Department of Abdominal Radiology, Hospital Moinhos de Vento, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Tara Sagebiel
- Diagnostic Radiology, UT MD Anderson Cancer Center, Houston, TX
| | - Madhavi Patnana
- Diagnostic Radiology, UT MD Anderson Cancer Center, Houston, TX
| | | | | | - Priya R Bhosale
- Diagnostic Radiology, UT MD Anderson Cancer Center, Houston, TX.
| |
Collapse
|
30
|
Carrasco-Choque AL, Lara YFD, Vivas-Bonilla I, Romero-Trejo C, Villa AR, Roldan-Valadez E. Perfusion volume correlates, percentage of involution, and clinical efficacy at diverse follow-up survey times after MR-guided focused ultrasound surgery in uterine fibroids: first report in a Mexican mestizo population. Eur Radiol 2015; 25:2905-12. [PMID: 25809744 DOI: 10.1007/s00330-015-3707-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 03/03/2015] [Accepted: 03/04/2015] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To evaluate the clinical efficacy of magnetic resonance-guided focused ultrasound surgery in a Mexican mestizo population. METHODS This retrospective study included 159 women (mean age 37 ± 6.4 years, range 22-53 years) from 2008 to 2010. Two hundred sixty-eight symptomatic uterine fibroids were treated using MR-guided focused ultrasound surgery. Parameters included initial perfused volume, final perfused volume, non-perfused volume (NPV), and treated volume ratio (TVR). Follow-up up to 15 months assessed treatment efficacy and symptomatic relief. Non-parametric statistics and the Kaplan-Meier method were performed. RESULTS T2-weighted hypointense fibroids showed a frequency of 93.6%; isointense and hyperintense fibroids had frequencies of 5.60 and 1.1%. There was a negative correlation between NPV and age (r = -0.083, p = 0.307) and treatment time (r = -0.253, p = 0.001). Median TVR was 96.0% in small fibroids and 76.5% in large fibroids. Involution of 50% and 80% was achieved at months 6-7 and month 11, respectively. Relief of symptoms was significant (p < 0.05). CONCLUSIONS Our data show that higher TVR attained immediately post-treatment of MRgFUS favours higher involution percentages at follow-up; however, careful patient selection and use of pretreatment imaging are important components for predicting success using MR-guided focused ultrasound surgery. KEY POINTS • Type 1 fibroids were the most common (93.2%). • Age and treated volume were not correlated (r s = -0.215, p = 0.165). • Small fibroids achieved a higher treated volume than large (96.0% vs. 76.5%). • A 50% involution was achieved at 6-month follow-up for type-1 fibroid. • A decrease of 80% was reached at 11 months for type-1 fibroids.
Collapse
|
31
|
Dashottar S, Singh AK, Debnath J, Muralidharan CG, Singh RK, Kumar S. Comparative analysis of changes in MR imaging of pre and post intrauterine progesterone implants in adenomyosis cases. Med J Armed Forces India 2015; 71:145-51. [PMID: 25859077 DOI: 10.1016/j.mjafi.2015.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 01/11/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Magnetic Resonance Imaging (MRI) plays an important role in the evaluation and management of adenomyosis. In this study, we first diagnosed the adenomyosis on MRI and then we analyzed the MRI changes in the uterus in pre and post intrauterine progesterone implants cases. METHOD All the patients with clinical diagnosis of menorrhagia or dysmenorrhea were screened by Ultrasonography (USG) of the pelvis. Patients with heterogeneous echo texture of the uterus were then evaluated by the MRI of the pelvis. All patients with MRI findings suggestive of adenomyosis formed the study group. RESULT On MRI study 60 patients were diagnosed as adenomyosis, 68.33% had diffuse adenomyosis and 31.66% had focal adenomyosis. 83% of diagnosed adenomyosis cases had high intensity signal foci which were seen in 75% cases of diffuse adenomyosis and 100% cases of focal adenomyosis. 50 diagnosed adenomyosis cases were then reviewed after 03 months, 06 months and 12 months to see for any change in the MRI findings in the post intrauterine implant cases. On follow up MRI after post progesterone intrauterine implant, 50% of the cases showed reduction in the high intensity signals, 10% of the cases showed mild reduction in the junctional zone thickness with no significant change in the uterine size. CONCLUSIONS It is inferred that MR imaging is not only helpful in diagnosing but also helpful in monitoring the effects of hormonal therapy in adenomyosis.
Collapse
Affiliation(s)
- S Dashottar
- Classified Specialist (Radiodiagnosis), Military Hospital (Cardio Thoracic Centre), Pune 410040, India
| | - A K Singh
- Senior Adviser (Radiodiagnosis), Army Hospital (R & R), New Delhi, India
| | - J Debnath
- Professor, Department of Radiodiagnosis, Armed Forces Medical College, Pune 411040, India
| | - C G Muralidharan
- Senior Adviser (Radiodiagnosis), Command Hospital (Southern Command), Pune 411040, India
| | - R K Singh
- Ex Deputy Commandant, Command Hospital (Eastern Command), Kolkata, India
| | - Suman Kumar
- Classified Specialist (Medicine and Clinical Hematology), Command Hospital (Eastern Command), Kolkata, India
| |
Collapse
|
32
|
Park Y, Kim MD, Jung DC, Lee SJ, Kim G, Park SI, Won JY, Lee DY. Can measurement of apparent diffusion coefficient before treatment predict the response to uterine artery embolization for adenomyosis? Eur Radiol 2014; 25:1303-9. [DOI: 10.1007/s00330-014-3504-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 10/26/2014] [Accepted: 11/13/2014] [Indexed: 11/30/2022]
|
33
|
Sudderuddin S, Helbren E, Telesca M, Williamson R, Rockall A. MRI appearances of benign uterine disease. Clin Radiol 2014; 69:1095-104. [PMID: 25017452 DOI: 10.1016/j.crad.2014.05.108] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 05/23/2014] [Indexed: 10/25/2022]
Abstract
Benign uterine disease is a common entity affecting women of all ages. Ultrasound has historically been the predominant imaging method used in the evaluation of benign gynaecological disease, magnetic resonance imaging (MRI) being reserved for use in the staging of malignant uterine and cervical disease. MRI is now increasingly used in the diagnosis of benign uterine disease as well as a tool for problem-solving in cases of diagnostic dilemma. It allows detailed assessment of benign conditions, such as endometrial lesions, leiomyomas, and adenomyosis, and can be helpful in the stratification of patients to different treatment modalities, including surgical resection, uterine artery embolization, and medical therapies. In this article, we review the MRI findings in the common benign uterine diseases.
Collapse
Affiliation(s)
- S Sudderuddin
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK.
| | - E Helbren
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | - M Telesca
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | - R Williamson
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| | - A Rockall
- Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London W12 0HS, UK
| |
Collapse
|
34
|
Tsai HJ, Hsu SM, Lee CK. Urethral obstruction caused by a hydrometra. Eur J Obstet Gynecol Reprod Biol 2014; 175:211-2. [PMID: 24513080 DOI: 10.1016/j.ejogrb.2013.12.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 12/23/2013] [Accepted: 12/31/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Horng-Jyh Tsai
- Department of Obstetrics and Gynecology, Kuang Tien General Hospital, Shalu Taichung, Taiwan.
| | - Soa-Min Hsu
- Department of Radiology, Kuang Tien General Hospital, Shalu Taichung, Taiwan
| | - Chien-Kuan Lee
- Department of Pathology, Kuang Tien General Hospital, Shalu Taichung, Taiwan
| |
Collapse
|
35
|
Abstract
Uterine fibroids are a major cause of morbidity in women of a reproductive age (and sometimes even after menopause). There are several factors that are attributed to underlie the development and incidence of these common tumors, but this further corroborates their relatively unknown etiology. The most likely presentation of fibroids is by their effect on the woman's menstrual cycle or pelvic pressure symptoms. Leiomyosarcoma is a very rare entity that should be suspected in postmenopausal women with fibroid growth (and no concurrent hormone replacement therapy). The gold standard diagnostic modality for uterine fibroids appears to be gray-scale ultrasonography, with magnetic resonance imaging being a close second option in complex clinical circumstances. The management of uterine fibroids can be approached medically, surgically, and even by minimal access techniques. The recent introduction of selective progesterone receptor modulators (SPRMs) and aromatase inhibitors has added more armamentarium to the medical options of treatment. Uterine artery embolization (UAE) has now been well-recognized as a uterine-sparing (fertility-preserving) method of treating fibroids. More recently, the introduction of ultrasound waves (MRgFUS) or radiofrequency (VizAblate™ and Acessa™) for uterine fibroid ablation has added to the options of minimal access treatment. More definite surgery in the form of myomectomy or hysterectomy can be performed via the minimal access or open route methods. Our article seeks to review the already established information on uterine fibroids with added emphasis on contemporary knowledge.
Collapse
Affiliation(s)
- Aamir T Khan
- Birmingham Women’s Hospital, Edgbaston, Birmingham, UK
| | | | - Janesh K Gupta
- Academic Department of Obstetrics and Gynaecology, University of Birmingham, Birmingham, UK
| |
Collapse
|
36
|
Takeda A, Imoto S, Sugiyama C, Nakamura H. Uterine Adenomyoma With Exophytic Subserosal Growth: Case Report of Rare Manifestation With Image Diagnosis and Laparoscopic-Assisted Excision. J Minim Invasive Gynecol 2013; 20:717-22. [DOI: 10.1016/j.jmig.2013.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 04/23/2013] [Accepted: 04/24/2013] [Indexed: 11/30/2022]
|
37
|
Decidualized adenomyosis during pregnancy and post delivery: three cases of magnetic resonance imaging findings. ACTA ACUST UNITED AC 2013; 38:851-7. [DOI: 10.1007/s00261-013-9988-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
38
|
Levy G, Dehaene A, Laurent N, Lernout M, Collinet P, Lucot JP, Lions C, Poncelet E. An update on adenomyosis. Diagn Interv Imaging 2012; 94:3-25. [PMID: 23246186 DOI: 10.1016/j.diii.2012.10.012] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Adenomyosis is a common benign uterine pathology that is defined by the presence of islands of ectopic endometrial tissue within the myometrium. It is asymptomatic in one third of cases, but when there are clinical signs they remain non-specific. It can often be misdiagnosed on sonography as it may be taken to be multiple uterine leiomyomata or endometrial thickening, both of which have a different prognosis and treatment. Adenomyosis is often associated with hormone-dependent pelvic lesions (myoma, endometriosis, or endometrial hyperplasia). It is less commonly connected to infertility or obstetrical complications and indeed any direct relationship remains controversial. The purpose of imaging is to make the diagnosis, to determine the extent of spread (focal or diffuse, superficial or deep adenomyosis, adenomyoma), and to check whether there is any associated disease, in particular endometriosis. The aim of this article is to provide assistance in recognising adenomyosis on imaging and to identify the pathologies that are commonly associated with it in order to guide the therapeutic management of symptomatic patients. Pelvic ultrasonography is the first line investigation. Sonohysterography can assist with diagnosis in some cases (pseudothickening of the endometrium seen on sonography). MRI may be used in addition to sonography to back up the diagnosis and to look for any associated disease.
Collapse
Affiliation(s)
- G Levy
- Women's Health Imaging, Jeanne-de-Flandre Hospital, Lille Regional University Hospital, 2, avenue Oscar-Lambret, 59037 Lille cedex, France.
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Prediction of early response to uterine arterial embolisation of adenomyosis: value of T2 signal intensity ratio of adenomyosis. Eur Radiol 2012; 22:2044-9. [DOI: 10.1007/s00330-012-2436-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Revised: 01/25/2012] [Accepted: 02/13/2012] [Indexed: 11/27/2022]
|
40
|
Dai Z, Feng X, Gao L, Huang M. Local excision of uterine adenomyomas: a report of 86 cases with follow-up analyses. Eur J Obstet Gynecol Reprod Biol 2012; 161:84-7. [DOI: 10.1016/j.ejogrb.2011.11.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2011] [Revised: 10/14/2011] [Accepted: 11/13/2011] [Indexed: 10/14/2022]
|
41
|
Heo SH, Lee KH, Kim JW, Jeong YY. Unusual manifestation of endometrioid adenocarcinoma arising from subserosal cystic adenomyosis of the uterus: emphasis on MRI and positron emission tomography CT findings. Br J Radiol 2011; 84:e210-2. [PMID: 22011824 DOI: 10.1259/bjr/24318075] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
There are several reports of adenocarcinoma developing within adenomyosis of the uterus, but imaging features of MRI, including diffusion-weighted imaging (DWI) and positron emission tomography (PET)-CT, have not been published. Herein we report a rare case of endometrioid adenocarcinoma arising from subserosal cystic adenomyosis to emphasise the unusual growth features, as well as the imaging findings of the tumour on MRI and PET-CT.
Collapse
Affiliation(s)
- S H Heo
- Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun-gun, Jeollanam-do, Korea
| | | | | | | |
Collapse
|
42
|
Fan TY, Zhang L, Chen W, Liu Y, He M, Huang X, Orsi F, Wang Z. Feasibility of MRI-guided high intensity focused ultrasound treatment for adenomyosis. Eur J Radiol 2011; 81:3624-30. [PMID: 21719223 DOI: 10.1016/j.ejrad.2011.05.036] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Revised: 05/23/2011] [Accepted: 05/25/2011] [Indexed: 12/01/2022]
Abstract
PURPOSE To test the feasibility of MRI-guided high intensity focused ultrasound ablation for adenomyosis. MATERIALS AND METHODS Patients with symptomatic adenomyosis were treated with MRI-guided high intensity focused ultrasound (MRIgHIFU). Under conscious sedation, MRIgHIFU was performed by a clinical MRI-compatible focused ultrasound tumour therapeutic system (JM15100, Haifu® Technology Co. Ltd., Chongqing, China) which is combined with a 1.5 T MRI system (Magnetom Symphony, Siemens Healthcare, Erlangen, Germany). MRI was used to calculate the volume of the uterus and lesion. Non-perfused volume of the targeted lesions was evaluated immediately after MRIgHIFU. Patient symptoms were assessed using symptom severity score (SSS) and uterine fibroids symptoms and quality of life questionnaire (UFS-QOL). RESULTS Ten patients with mean age of 40.3±4 years with an average lesion size of 56.9±12.7 mm in diameter were treated. Non-perfused volume and the percentage of non-perfused volume obtained from contrast-enhanced T1 Magnetic resonance images immediately post-treatment were 66.6±49.4 cm3 and 62.5±21.6%, respectively. The mean SSS and UFS-QOL showed significant improvements of 25%, 16% and 25% at 3, 6 and 12 months follow up, respectively, to pre-treatment scores. No serious complications were observed. CONCLUSION Based on the results from this study, MRIgHIFU treatment appears to be a safe and feasible modality to ablate adenomyosis lesion and alleviate its symptoms.
Collapse
Affiliation(s)
- Tien-Ying Fan
- State Key Laboratory of Ultrasound Engineering in Medicine, Department of Biomedical Engineering, Chongqing Medical University, Clinical Center of Tumor Therapy, 2nd Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | | | | | | | | | | | | | | |
Collapse
|
43
|
MRI Characteristics of the Uterine Junctional Zone: From Normal to the Diagnosis of Adenomyosis. AJR Am J Roentgenol 2011; 196:1206-13. [DOI: 10.2214/ajr.10.4877] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
44
|
Kim KA, Yoon SW, Lee C, Seong SJ, Yoon BS, Park H. Short-term results of magnetic resonance imaging-guided focused ultrasound surgery for patients with adenomyosis: symptomatic relief and pain reduction. Fertil Steril 2011; 95:1152-5. [PMID: 20970127 DOI: 10.1016/j.fertnstert.2010.09.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Revised: 08/19/2010] [Accepted: 09/16/2010] [Indexed: 11/25/2022]
Abstract
The objective of this study was to evaluate the degree of symptomatic relief obtained after treatment with magnetic resonance-guided focused ultrasound surgery in patients with adenomyosis. Quality of life and pain assessment questionnaires from 35 women, collected on the day of treatment and up to 6 months after treatment, indicated that the treatment was safe and there was a significant reduction in symptoms.
Collapse
Affiliation(s)
- Kyoung Ah Kim
- Department of Diagnostic Radiology, CHA Bundang Medical Center, CHA University, Gyunggi-do, South Korea
| | | | | | | | | | | |
Collapse
|
45
|
Ward JF. High-Intensity Focused Ultrasound for Therapeutic Tissue Ablation in Surgical Oncology. Surg Oncol Clin N Am 2011; 20:389-407, ix. [DOI: 10.1016/j.soc.2010.11.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
46
|
Takeuchi M, Matsuzaki K. Adenomyosis: Usual and Unusual Imaging Manifestations, Pitfalls, and Problem-solving MR Imaging Techniques. Radiographics 2011; 31:99-115. [DOI: 10.1148/rg.311105110] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
47
|
Abstract
PURPOSE OF REVIEW To introduce recent developments in a noninvasive treatment of using high-intensity focused ultrasound (HIFU) for ablating uterine localized adenomyosis, and to discuss their potential in this application. RECENT FINDINGS This literature roughly reviewed conservative therapy for uterine localized adenomyosis and emphasized using HIFU for ablating it. The main histological change of HIFU treatment was the coagulative necrosis of adenomyosis cells, with damage on small blood vessels of adenomyoma. MR-guided focused ultrasound surgery (MRgFUS) and ultrasound-guided HIFU ablation of focal adenomyosis were with satisfactory results. MRgFUS was less invasive and safely ablated adenomyosis tissue close to the endometrium or to serosal surface. HIFU might be safe and effective for treating patients with adenomyosis, and the acoustic intensity was a key factor for therapeutic efficacy as the severity of symptoms might correlate with lesion extent in some patients. At a given therapeutic dose, the influence of acoustic intensity on focal temperature rise was greater than that of exposure time. Some other experiments showed that the size of adenomyoma was increased 3-4 months after HIFU treatment. The reasons were related to the size of tumor, treatment parameters, operation procedure, and the blood supply of the targeted tissue. Although recent results have been very encouraging, further trials are essential to evaluate the long-term efficacy, and cost-effectiveness of HIFU ablation in localized adenomyosis. SUMMARY Compared with current conservative treatments, HIFU may be a noninvasive approach and may offer complete ablation of adenomyoma, with less trauma, less complication, and low cost and short hospital stay for treating patients with uterine localized adenomyosis.
Collapse
|
48
|
Song SE, Sung DJ, Park BJ, Kim MJ, Cho SB, Kim KA. MR imaging features of uterine adenomyomas. ACTA ACUST UNITED AC 2010; 36:483-8. [DOI: 10.1007/s00261-010-9640-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
49
|
Wang W, Wang Y, Tang J. Safety and efficacy of high intensity focused ultrasound ablation therapy for adenomyosis. Acad Radiol 2009; 16:1416-23. [PMID: 19683943 DOI: 10.1016/j.acra.2009.06.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2009] [Revised: 06/08/2009] [Accepted: 06/09/2009] [Indexed: 11/18/2022]
Abstract
RATIONALE AND OBJECTIVES In patients with adenomyosis, the severity of symptoms correlates roughly with the extent of adenomyosis. Thus, it was hypothesized that the ablation of enough volume of adenomyosis might alleviate symptoms. The aim of this study was to investigate the safety and efficacy of high-intensity focused ultrasound (HIFU) ablation for the treatment of adenomyosis. MATERIALS AND METHODS Phase I HIFU ablation of adenomyosis was performed on 12 patients. Three patients each were treated using four different acoustic intensities (290, 340, 380, and 420 W) step by step. Contrast-enhanced ultrasound was used to evaluate the necrotic region of treated adenomyosis. The efficacy of therapy was evaluated after 3 months of follow-up. RESULTS All patients in the four groups tolerated the therapy well, and no severe complications were found during follow-up. After treatment, nonenhanced necrotic regions were shown on contrast-enhanced ultrasound in all treated adenomyosis. The mean volumes of the nonenhanced regions were 72, 75, 68, and 124 cm(3) in the 290-W, 340-W, 380-W, and 420-W groups, respectively. At 3 months after therapy, the mean pain relief in the four groups was 25%, 58.3%, 66.7%, and 83.3%, respectively. CONCLUSIONS HIFU may be a safe and effective method to treat adenomyosis, and an acoustic intensity of 420 W may be able to produce larger volumes of necrosis and better pain relief.
Collapse
Affiliation(s)
- Wei Wang
- Department of Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China.
| | | | | |
Collapse
|
50
|
Fukunishi H, Funaki K, Sawada K, Yamaguchi K, Maeda T, Kaji Y. Early results of magnetic resonance-guided focused ultrasound surgery of adenomyosis: analysis of 20 cases. J Minim Invasive Gynecol 2008; 15:571-9. [PMID: 18657480 DOI: 10.1016/j.jmig.2008.06.010] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2008] [Revised: 06/16/2008] [Accepted: 06/21/2008] [Indexed: 10/21/2022]
Abstract
STUDY OBJECTIVE To evaluate the thermal ablative effects of magnetic resonance-(MR) guided focused ultrasound surgery (MRgFUS) on adenomyosis and to assess improvement in clinical parameters. DESIGN Twenty patients with adenomyosis were treated with MRgFUS. Extensive adenomyosis (6 cases) was treated with 2 applications. Uterine volume was evaluated by MR imaging before and immediately after MRgFUS. Ablation of adenomyosis and the architecture of nonperfused areas were evaluated immediately after MRgFUS. Improvement in patient symptoms was assessed through the symptom severity score questionnaire (Canadian Task Force classification II-3). SETTING Department of gynecology at a Japanese general hospital. PATIENTS Premenopausal women at least 18 years of age with symptomatic adenomyosis. INTERVENTIONS Thermal ablation by MRgFUS. MEASUREMENTS AND MAIN RESULTS We classified the nonperfused lesions on contrast-enhanced MR images immediately after MRgFUS into 3 types: lesions with round margins (type R), serrated margins (type S), and honeycomb architecture (type H). Type R was the most common (16/20 patients). Most adenomyosis lesions could be sufficiently ablated close to the serosal surface or to the endometrium by MRgFUS. The mean uterine volume 6 months after therapy was decreased by 12.7%. Symptom severity score improved significantly during 6 months of follow-up. No serious complications were observed. CONCLUSION These early results indicate the safe and effective ablation of adenomyosis tissue by MRgFUS. The procedure also resulted in the improvement in clinical symptoms during the 6 months of follow-up.
Collapse
Affiliation(s)
- Hidenobu Fukunishi
- Department of Gynecology, Shinsuma General Hospital, and Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan.
| | | | | | | | | | | |
Collapse
|