From the Department of Radiology, Einstein Healthcare Network, 5501 Old York Rd, Philadelphia, PA 19141.
Radiographics. 2018 Sep-Oct;38(5):1576-1589. doi: 10.1148/rg.2018180080.
Adenomyosis is a common benign uterine condition and a frequent cause of pelvic pain in premenopausal women. Transvaginal US is now considered the primary imaging modality for the diagnosis of adenomyosis, and thus radiologists should be familiar with its sonographic appearance. US findings can be divided into three categories, which parallel the histology of adenomyosis: (a) ectopic endometrial glands and stroma, (b) muscular hyperplasia/hypertrophy, and (c) increased vascularity. Ectopic endometrial glands manifest as echogenic nodules and striations, radiating from the endometrium into the myometrium. When the glands contain fluid, myometrial cysts and fluid-filled striations may be visible at US. Muscular hyperplasia and hypertrophy cause focal or diffuse myometrial thickening and globular uterine enlargement, often with thin "venetian blind" shadows. The combination of these findings results in a heterogeneous myometrium, with blurring of the endometrial border. Adenomyosis increases uterine vascularity, depicted as a pattern of penetrating vessels at color Doppler US. Other US techniques that are helpful in the diagnosis of adenomyosis include obtaining cine clips and coronal reformatted images, both of which can survey the entire endometrial-myometrial border, and performing saline-infusion sonohysterography, during which ectopic glands frequently fill with either air or fluid. While most cases of adenomyosis develop spontaneously, there are specific inciting causes that include tamoxifen use, postendometrial ablation syndrome, and deep-infiltrating endometriosis. Mimics of adenomyosis include leiomyomas, uterine contractions, neoplasms, and vascular malformations. This article reviews the pathophysiology of adenomyosis and correlates it with the US findings, highlights specific causes of adenomyosis, and describes how to distinguish this common diagnosis from a variety of mimics. Online supplemental material is available for this article. RSNA, 2018.
子宫腺肌病是一种常见的良性子宫疾病，也是绝经前妇女盆腔痛的常见原因。经阴道超声检查目前被认为是诊断子宫腺肌病的主要影像学手段，因此放射科医生应该熟悉其超声表现。超声表现可分为三类，与子宫腺肌病的组织学相对应：（a）异位子宫内膜腺体和基质，（b）肌层增生/肥厚，和（c）血管增多。异位子宫内膜腺体表现为回声结节和条纹，从子宫内膜向肌层放射。当腺体含有液体时，肌层囊肿和充满液体的条纹可能在超声上可见。肌层增生和肥厚导致局灶性或弥漫性子宫肌层增厚和球形子宫增大，常伴有薄的“百叶窗”阴影。这些表现的组合导致子宫肌层不均匀，子宫内膜边界模糊。子宫腺肌病增加子宫血管生成，在彩色多普勒超声上表现为穿透性血管模式。有助于诊断子宫腺肌病的其他超声技术包括获取电影剪辑和冠状重建图像，这两种技术都可以检查整个子宫内膜-肌层边界，并进行盐水灌注超声检查，在此期间异位腺体常充满空气或液体。虽然大多数子宫腺肌病是自发发生的，但有特定的诱发原因，包括他莫昔芬使用、子宫内膜消融后综合征和深部浸润性子宫内膜异位症。子宫腺肌病的模拟物包括子宫肌瘤、子宫收缩、肿瘤和血管畸形。本文回顾了子宫腺肌病的病理生理学，并将其与超声表现相关联，强调了子宫腺肌病的特定病因，并描述了如何将这一常见诊断与多种模拟物区分开来。本文提供了在线补充材料。RSNA，2018 年。
