Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
Semin Reprod Med. 2020 May;38(2-03):119-128. doi: 10.1055/s-0040-1719017. Epub 2020 Nov 16.
Uterine adenomyosis can be diagnosed on ultrasonography (US) and magnetic resonance imaging (MRI) with a high degree of accuracy. Adenomyosis is a myometrial process that can appear as diffuse or focal on imaging. Diffuse adenomyosis typically causes uterine enlargement, while focal adenomyosis can mimic other myometrial lesions, such as leiomyomas. Imaging features frequently seen on US include a heterogenous thickened myometrium and myometrial cysts. On MRI, widening of the junctional zone, whether focal or diffuse, and the presence of myometrial cysts, either simple or hemorrhagic, support the diagnosis of adenomyosis. Despite these characteristic imaging appearances, there are several gynecologic pathologies which can mimic adenomyosis and it is important to be vigilant of these when interpreting cross-sectional imaging exams. The decision to evaluate patients with US or MRI is contingent on multiple factors, including availability of the necessary technology and expertise for the latter. However, MRI appears to offer greater specificity and positive predictive value for the diagnosis of adenomyosis.
子宫腺肌病可以通过超声（US）和磁共振成像（MRI）高度准确地诊断。腺肌病是一种肌层疾病，在影像学上可以表现为弥漫性或局灶性。弥漫性腺肌病通常导致子宫增大，而局灶性腺肌病可能类似于其他子宫肌层病变，如子宫肌瘤。US 上常见的影像学特征包括不均匀增厚的子宫肌层和子宫肌层囊肿。在 MRI 上，无论是局灶性还是弥漫性，交界区增宽，以及存在单纯或出血性的子宫肌层囊肿，均支持腺肌病的诊断。尽管这些影像学表现具有特征性，但仍有几种妇科疾病可能与腺肌病相混淆，因此在解读横断面影像学检查时需要对此保持警惕。是否选择使用 US 或 MRI 来评估患者取决于多个因素，包括是否具备后者所需的技术和专业知识。然而，MRI 似乎在诊断腺肌病方面具有更高的特异性和阳性预测值。
