0:02

Okay, so to wrap up our adenomyosis lesson,

0:05

a few teaching points to consider whenever

0:07

you're looking for this diagnosis in a patient.

0:10

Just remember, it really does have a

0:11

variable appearance on ultrasound and MRI.

0:14

It may have one of the features,

0:15

it may have more of the features.

0:17

Easier to diagnose when it has more than

0:19

one feature, of course, but it's also wise

0:21

to suggest that even if you only see one or

0:23

two, even if you have to hedge a little bit.

0:26

So things that you're looking for,

0:28

you're looking for echogenic or cystic

0:30

foci or striations emanating from

0:33

that endometrium into the myometrium.

0:35

That's the ultrasound appearance.

0:36

The correlate on MRI are going to be

0:38

T2 bright foci or little striations.

0:42

You're going to look for poorly defined

0:44

borders if it's more of an almost sort of

0:45

mass-like structure right there, and that's

0:47

going to separate it from the fibroid.

0:49

That goes for both ultrasound and

0:51

for MRI, poorly defined borders.

0:53

Often on MRI, an adenomyoma specifically

0:56

may be ovoid in shape as well as opposed

0:58

to fibroids which tend to be fairly round.

1:02

And then lastly, you want

1:03

to consider vascularity.

1:05

Those penetrating vessels on color Doppler,

1:07

not always present, but when they are, you can

1:09

be pretty sure you're looking at adenomyosis.

1:11

That's going to be different than a fibroid.

1:13

We're going to have more of a

1:14

circumferential pattern of the vascularity.

Adenomyosis – Teaching Points

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0:02

Okay, so to wrap up our adenomyosis lesson,

0:05

a few teaching points to consider whenever

0:07

you're looking for this diagnosis in a patient.

0:10

Just remember, it really does have a

0:11

variable appearance on ultrasound and MRI.

0:14

It may have one of the features,

0:15

it may have more of the features.

0:17

Easier to diagnose when it has more than

0:19

one feature, of course, but it's also wise

0:21

to suggest that even if you only see one or

0:23

two, even if you have to hedge a little bit.

0:26

So things that you're looking for,

0:28

you're looking for echogenic or cystic

0:30

foci or striations emanating from

0:33

that endometrium into the myometrium.

0:35

That's the ultrasound appearance.

0:36

The correlate on MRI are going to be

0:38

T2 bright foci or little striations.

0:42

You're going to look for poorly defined

0:44

borders if it's more of an almost sort of

0:45

mass-like structure right there, and that's

0:47

going to separate it from the fibroid.

0:49

That goes for both ultrasound and

0:51

for MRI, poorly defined borders.

0:53

Often on MRI, an adenomyoma specifically

0:56

may be ovoid in shape as well as opposed

0:58

to fibroids which tend to be fairly round.

1:02

And then lastly, you want

1:03

to consider vascularity.

1:05

Those penetrating vessels on color Doppler,

1:07

not always present, but when they are, you can

1:09

be pretty sure you're looking at adenomyosis.

1:11

That's going to be different than a fibroid.

1:13

We're going to have more of a

1:14

circumferential pattern of the vascularity.

Report

Faculty

Kathryn McGillen, MD

Assistant Professor of Radiology, Medical Director of Ultrasound

Penn State University Milton S Hershey Medical Center

Lesson

Pre-Course Activities

Lesson

Introduction to Uterine Imaging and Normal Anatomy

Lesson

Mullerian Duct Anomalies

Lesson

Intrauterine Device (IUD)

Lesson

Adenomyosis

Lesson

Fibroids

Lesson

Endometrium

Lesson

Special Considerations – Post Pregnancy

Adenomyosis – Teaching Points