Tocci Angelo, Greco Ermanno, Ubaldi Filippo Maria
Reproductive Medicine Unit, European Hospital, Rome, Italy.
Reprod Biomed Online. 2008 Aug;17(2):281-91. doi: 10.1016/s1472-6483(10)60207-6.
The diagnosis of adenomyosis is feasible on pathological specimen examination, while it is unreliable on clinical findings, biopsy, hysteroscopy, sonohysterography, and routine ultrasound or magnetic resonance imaging. Several patterns of 'abnormality' described on imaging have been linked to adenomyosis, but the correlation is weak and the diagnostic accuracy is low outside of a research context. Nevertheless, thickening or abnormality of the subendometrial myometrium, the outer part of the 'endometrial-subendometrial myometrium unit' (thought to be important in human fertility) has been repeatedly documented on imaging, called 'adenomyosis' and linked to infertility. This paper discusses the value of the physiological endometrial-subendometrial myometrium unit in human fertility, reviews the current criteria for its imaging, and reports on its relationship to fertility. It is proposed that endometrial-subendometrial myometrium unit disruption disease is considered as a new entity (distinguished from adenomyosis), the diagnosis of which is feasible and straightforward on imaging and expressed mainly by pathological thickening or abnormality of the subendometrial myometrium (myometrial halo or junctional zone). The study also reports on the influence of abnormal thickening or disruption on human fertility and outcome of assisted reproduction techniques, and demonstrates that this new entity is epidemiologically different from adenomyosis.
子宫腺肌病的诊断在病理标本检查时是可行的，而在临床表现、活检、宫腔镜检查、子宫声学造影以及常规超声或磁共振成像检查时则不可靠。影像学上描述的几种“异常”模式与子宫腺肌病有关，但这种相关性较弱，在研究背景之外诊断准确性较低。尽管如此，子宫内膜下肌层（“子宫内膜-子宫内膜下肌层单元”的外层部分，被认为对人类生育至关重要）增厚或异常在影像学上已被反复记录，称为“子宫腺肌病”并与不孕相关。本文讨论了生理性子宫内膜-子宫内膜下肌层单元在人类生育中的价值，回顾了其影像学检查的现行标准，并报告了其与生育的关系。有人提出，子宫内膜-子宫内膜下肌层单元破坏疾病应被视为一种新的实体（与子宫腺肌病相区分），其诊断在影像学上可行且直接，主要表现为子宫内膜下肌层（肌层晕或交界区）的病理性增厚或异常。该研究还报告了异常增厚或破坏对人类生育及辅助生殖技术结局的影响，并表明这种新实体在流行病学上与子宫腺肌病不同。
