0:01

So we're going to switch gears a little bit

0:02

and we're going to move to

0:03

4 00:00:04,140 --> 00:00:04,290

0:03

MRI imaging of adenomyosis.

0:06

So this is a patient who was

0:08

50 years old and had rectal cancer.

0:10

So she got a rectal cancer MRI

0:12

10 00:00:12,370 --> 00:00:12,549

0:12

for incidental or for staging purposes.

0:15

And again, we're radiologists,

0:16

you have to look at everything.

0:18

So we look at the uterus as well.

0:20

So in her case, she has a very

0:22

T2 dark fibroid, very well defined,

0:24

but we're not gonna talk about that now

0:25

'cause we're talking about adenomyosis.

0:27

So what we're looking for here is,

0:29

this is a good example of a

0:30

thickened T2 dark junctional zone.

0:33

It's a little bit asymmetric.

0:34

So here's your T2 bright

0:35

endometrium. That line in the middle

0:37

is the anterior and posterior endometrium

0:39

where they oppose each other and meet.

0:42

This T2 dark junctional zone is thick,

0:44

however, it's about 19 millimeters.

0:46

In general, it should be

0:48

less than eight millimeters.

0:49

If it were between 8 to 12 millimeters,

0:51

it's sort of a gray zone, but if you're

0:52

more than 12 millimeters, it's too

0:54

thick, you definitely have adenomyosis.

0:57

You can see it's asymmetric posteriorly,

1:00

where it's not nearly quite as thick.

1:01

So this is just the muscular hypertrophy,

1:04

we don't see any of this T2 bright foci.

1:06

This is just thickening of adenomyosis.

1:07

41 00:01:10,255 --> 00:01:12,345 It is important to think about other things

1:12

that could mimic this, you know, are you

1:13

in a slightly off plane of view because

1:15

this was done for rectal cancer staging,

1:18

the uterus might not be perfectly in plane.

1:20

You can have mimics such

1:22

as a uterine contraction.

1:23

So if you have multiple phases, you can see

1:25

if that relaxes at some point over time.

1:28

And occasionally later in a menstrual

1:30

cycle, you could potentially have

1:32

a little bit of thickening there.

1:33

So again, no T2 bright foci in this case.

1:36

It's just the hypertrophied junctional zone here.

1:39

In her particular case, too, she

1:41

does have a C-section scar, just

1:43

some other incidental findings here.

1:45

On this particular image, too, it looks

1:46

like it may even have an adhesion to

1:47

the bladder right here, potentially,

1:50

but hard to tell because, again, this

1:51

was performed for rectal cancer staging,

1:53

not specifically to evaluate the uterus.

1:55

And then a few T2 bright Nabothian cysts

1:58

in the cervix, which, again, pretty common.