Reinhold C, Tafazoli F, Mehio A, Wang L, Atri M, Siegelman E S, Rohoman L
Department of Radiology, Montreal General Hospital and McGill University, Quebec, Canada.
Radiographics. 1999 Oct;19 Spec No:S147-60. doi: 10.1148/radiographics.19.suppl_1.g99oc13s147.
Uterine adenomyosis is a common gynecologic condition that is characterized by the presence of heterotopic endometrial glands and stroma in the myometrium with adjacent smooth muscle hyperplasia. The histopathologic features of adenomyosis are varied and contribute to its imaging appearance. The accompanying smooth muscle hyperplasia produces the typical gross appearance of adenomyosis and corresponds to areas of decreased echogenicity at endovaginal ultrasonography (US) and areas of decreased signal intensity at magnetic resonance (MR) imaging. Endovaginal US also shows heterogeneity of the myometrial echotexture, which corresponds to small echogenic islands of heterotopic endometrial tissue surrounded by the hypoechoic smooth muscle. On T2-weighted MR images, bright foci are seen in areas of abnormal low signal intensity within the myometrium in approximately 50% of patients. These foci correspond to islands of heterotopic endometrial tissue, cystic dilatation of heterotopic glands, or hemorrhagic foci. With the advent of high-resolution imaging techniques, signs associated with the presence of heterotopic endometrial tissue are being detected with increasing frequency. These signs include myometrial cysts, myometrial nodules, linear striations, pseudowidening of the endometrium, and poor definition of the endomyometrial junction. Pitfalls in diagnosis of uterine adenomyosis include leiomyoma, endometrial carcinoma, myometrial contractions, and muscular hypertrophy.
子宫腺肌病是一种常见的妇科疾病，其特征是子宫肌层存在异位的子宫内膜腺体和间质，并伴有相邻平滑肌增生。腺肌病的组织病理学特征多种多样，这导致了其影像学表现。伴随的平滑肌增生产生了腺肌病典型的大体外观，在经阴道超声检查（US）中对应于低回声区域，在磁共振成像（MR）中对应于信号强度降低的区域。经阴道超声还显示子宫肌层回声纹理不均匀，这对应于被低回声平滑肌包围的异位子宫内膜组织的小回声岛。在T2加权磁共振图像上，约50%的患者子宫肌层内异常低信号强度区域可见明亮病灶。这些病灶对应于异位子宫内膜组织岛、异位腺体的囊性扩张或出血灶。随着高分辨率成像技术的出现，与异位子宫内膜组织存在相关的征象被检测到的频率越来越高。这些征象包括子宫肌层囊肿、子宫肌层结节、线状条纹、子宫内膜假性增宽以及内膜肌层交界不清。子宫腺肌病诊断中的陷阱包括平滑肌瘤、子宫内膜癌、子宫肌层收缩和肌肉肥大。
