0:01

Our next case, another pelvic MRI,

0:04

which shows some classic findings of adenomyosis.

0:05

We'll start with our T2, and you can see

0:09

this was pretty marred by breathing artifacts

0:11

here, all of our artifact right here

0:13

that's occurring, but it's still diagnostic.

0:15

So, your pubic symphysis here, sacrum back

0:17

here, spinal canal back here, bladder up

0:21

here, urethra is going to be somewhere

0:23

in here, vagina somewhere here, rectum

0:25

coming down here, anal canal, just to again

0:27

give you an idea exactly where we are.

0:30

Cervix in this case is going to be

0:31

back here, we're a little bit off

0:32

axis which can happen with the uterus.

0:35

Here's your nice thin endometrium in

0:37

this particular case, and then we have

0:39

a very large globular uterus, right?

0:41

And it's very asymmetric.

0:43

Anteriorly, it looks pretty good.

0:44

We don't really have a T2 dark, thick,

0:47

and junctional zone per se in this person.

0:49

It's really hard even to find it discreetly,

0:52

but what we do have is we have this sort

0:54

of ill-defined structure in the posterior

0:56

uterus that has multiple T2 bright foci,

0:59

28 00:00:59,665 --> 00:00:59,804

1:00

poorly defined walls here.

1:01

It doesn't look like a fibroid necessarily.

1:03

It's not that T2 dark.

1:04

They're usually pretty T2 dark.

1:07

And would have well-defined walls,

1:08

which this doesn't have, so this is a pretty

1:10

classic T2 bright foci of adenomyosis.

1:14

Usually sagittal, I like that the best

1:16

for looking for those particular entities,

1:19

but in this case, you can see it too.

1:22

Like it's very nicely shown on

1:23

the actual image, so again, cervix

1:25

down here, endometrium coming up.

1:27

You have a really large globular uterus, right?

1:30

That's really rounded like a globe.

1:32

And you can see here's the endometrium here.

1:34

And this just ill-defined structure back

1:36

here, no well-defined borders, a little bit

1:39

darker than the rest of the myometrium with

1:41

T2 bright foci scattered throughout it.

1:43

This is classic, classic adenomyosis,

1:47

asymmetric, elliptical shape, poorly defined

1:50

borders, and in this case, somewhat focal.