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Adenomyosis – Problem Solving with MRI

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Our next case is of a 52-year-old.

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She was diagnosed with a fibroid on an outside

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hospital ultrasound, which you can see here.

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Just giving you the cine clips through it.

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They threw some measurement calipers on this

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structure, and it was called a large fibroid.

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Because she was having pain and

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discomfort from this, she was referred

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to a pre-EMBO evaluation via MRI.

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Before we go to that, you already know

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you're in the adenomyosis portion of

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this, so some of the features you can look

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for in this that tell you that it is not

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actually a fibroid, or can at least make

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you think maybe, maybe not type of thing.

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We do have some well-defined borders,

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so that can certainly push you towards fibroid.

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But we do also have venetian blind sign

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right here, and we have a lot of it.

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The other thing that threw me off from

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fibroid is fibroid is a mass-like process.

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Here's your endometrium right here and you

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have this on both sides of the endometrium.

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So fibroid can't really

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span the endometrium, again,

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anterior and posterior round, almost

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wrapping around the endometrium.

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Fibroids can't do that.

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So it should make you start to think that maybe

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this isn't a fibroid, maybe it's something else.

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So in this case, the MRI is performed for

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preoperative embolization purposes,

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but also for diagnostic purposes as well.

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So here's our preoperative MRI.

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Again, the sagittal is a little bit

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limited by respiratory motion,

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but it's still more than diagnostic.

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So we can already see, too, again,

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confirms the ultrasound findings.

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We have a very large uterus, quite globular,

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very rounded, globe-like, if you will.

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Here's your very thin endometrium.

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And you can already see this process

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is pretty symmetric on both sides

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of the endometrium right here.

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We don't have any well-

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defined borders at this point.

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You can sort of see where we have

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some maybe normal myometrium,

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but it just sort of blends in.

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We definitely have T2 bright foci

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as well as we go through this.

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The coronal image, you don't have nearly as

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much motion problems or respiratory issues

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here, so you can see it a little bit better.

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Again, endometrium right here centrally

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pushed off maybe a little bit to the left,

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but this sort of ill-defined T2 dark structure

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with lots of T2 bright foci within it.

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And here's your axial, you can see even sort

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of pushes the endometrium off to the right here.

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And you can see T2 bright foci, this ill-defined

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mass-like structure that enlarges the ovary.

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Non-mass, like in the sense that there's no

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well-defined borders, this is adenomyosis.

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And just another little fun finding in your

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pre-contrast T1, you can actually see some of

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the little hemorrhagic deposits because this is

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endometrial tissue, so it can absolutely bleed.

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Sometimes it can get stuck behind there

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and you have these little bright foci of blood products within them.

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So this ended up not being a fibroid,

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so they didn't necessarily

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a uterine artery embolization to treat

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a fibroid because it's not a fibroid.

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You can do UAE for adenomyosis, may not be

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quite as effective in symptom management,

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depending on what your symptoms were

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as it is for fibroids, but it'd be

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something to consider and to talk about.

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Other thing you could think about in this

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particular case, you know, could this

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be some sort of uterine carcinoma here?

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I would argue it's very

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respectful of that endometrium.

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It doesn't really pushes it away.

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It doesn't narrow.

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It's not irregular.

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And in this particular case, these studies

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were nearly a year apart from her oldest study.

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So this was stable.

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So we knew this wasn't a uterine carcinoma

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or sarcoma, something like that,

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but this was just plain adenomyosis,

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just a very large fragment of it.

Report

Faculty

Kathryn McGillen, MD

Assistant Professor of Radiology, Medical Director of Ultrasound

Penn State University Milton S Hershey Medical Center

Tags

Vascular

Uterus

Ultrasound

MRI

Idiopathic

Gynecologic (GYN)

Body

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