Uterine adenomyosis with extensive glandular proliferation: case series of a rare imaging variant.

Yudai Nakai, Eriko Maeda, Tomonori Kanda, Masako Ikemura, Tetsuo Ushiku, Yuko Sasajima, Saiko Isshiki, Osamu Abe

Diagnostic and interventional radiology (Ankara, Turkey) 2020 May

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We aimed to investigate the clinical and magnetic resonance imaging (MRI) characteristics of uterine adenomyosis, in which there is an extensive area of high signal intensity in the myometrium on T2-weighted MRI. This retrospective radiographic study reviewed a case series of six patients (mean age, 36 years) with adenomyosis. These patients were selected because, unlike in classical adenomyosis, T2-weighted images showed a larger area of high signal intensity than that of low signal intensity in the myometrium. The morphology of the myometrial lesions, patterns of contrast enhancement (n=4), intramyometrial hemorrhaging, diffusion restriction (n=5), endometrial lesions, and imaging findings after treatment (n=3) were evaluated on MRI. The patients' clinical symptoms included vaginal bleeding and severe anemia. Four were administered hormonal therapy, one underwent hysterectomy, and one underwent enucleation. On T2-weighted images, all showed endometrial thickening and a high signal intensity area in the myometrium that was divided up by a mesh of low signal intensity bands, with an appearance reminiscent of a fish caught in a net. Other findings included gradual centripetal enhancement with contrast defects in multicystic areas (4/4), an intramyometrial hemorrhage (1/6), and increased diffusion (5/5). Following hormonal therapy, the uteruses decreased in size and were similar to those of classical adenomyosis on MRI (3/3). The lesions were diagnosed as adenomyosis with a proliferation of adenomyotic glandular tissue and a proliferative endometrial polyp. This case series suggests that there is a subgroup of uterine adenomyosis that shows a characteristic "fish-in-a-net" appearance on T2-weighted images.

Citation

Yudai Nakai, Eriko Maeda, Tomonori Kanda, Masako Ikemura, Tetsuo Ushiku, Yuko Sasajima, Saiko Isshiki, Osamu Abe. Uterine adenomyosis with extensive glandular proliferation: case series of a rare imaging variant. Diagnostic and interventional radiology (Ankara, Turkey). 2020 May;26(3):153-159