"irregular endometrial–myometrial junction 19"
"A "Venetian blind" or "rain shower" appearance (linear striations, parallel shadowing) may be seen as a combination of the aforementioned features: heterogeneous 1,2,20, coarsened echotexture of the myometrium, and acoustic shadowing where endometrial tissues cause a hyperplastic reaction. The combination of this heterogeneity and the subendometrial echogenic nodular and linear striations is not dissimilar to the appearance of chronic liver parenchymal disease - hence, “cirrhosis of the uterus.”"
"direct: indicate the presence of ectopic endometrial tissue within the myometrium."
"indirect: reflect secondary myometrial changes due to adenomyosis."
"Classically, adenomyosis most commonly affects multiparous women of reproductive age. However, this is based on the results of studies with pathologic examinations of hysterectomy specimens, therefore biassed towards patients who had surgery. Similarly, this may be the reason adenomyosis is seen with higher frequency in women with a history of uterine surgical procedures (e.g. Caesarean section, dilatation and curettage). Patients with high oestrogen exposure (e.g. short menstrual cycles, early menarche) have an increased risk of adenomyosis."
"The reported incidence ranges widely from 5-70% (mean 20-30%), depending on the histological definition or the imaging modality used 12. Adenomyosis is relatively rare in postmenopausal women, but a higher incidence of adenomyosis has been reported in women treated with tamoxifen for breast cancer 12."
"Morphological Uterus Sonographic Assessment (MUSA) consensus"
"The MUSA consensus was first published in 2015 with the aim to refine the diagnostic criteria and standardise ultrasound reporting of adenomyosis 17, 23. The latest revision in 2021 classifies US features of adenomyosis into direct and indirect features 21."
"T1: foci of high T1 signal are often seen, indicating menstrual haemorrhage into the ectopic endometrial tissues 7"
"T2: typically, a region of adenomyosis appears as an ill-defined ovoid/diffuse region of thickening, often with small high T2 signal regions representing small areas of cystic change"
"T1 C+ (Gd): contrast-enhanced MRI evaluation is usually not required for evaluation of adenomyosis, however, if performed, shows enhancement of the ectopic endometrial glands"
Expected headings
"Associations"
"Morphological Uterus Sonographic Assessment (MUSA) consensus"
"Fluoroscopy"
"Most patients with adenomyosis are asymptomatic. Symptoms include secondary dysmenorrhoea, heavy menstrual bleeding, dyspareunia, chronic pelvic pain and menometrorrhagia 11. The pain is characteristically cyclical, beginning shortly before menses and persisting throughout, and typically becomes more severe over successive cycles; a proportion of patients also report non-cyclical chronic pelvic pain. Symptom severity correlates poorly with the extent of disease on imaging. Pelvic tenderness on examination is associated with diffuse enlargement of the uterus."
"Because the ectopic tissue is basalis-derived, it does not undergo the full cyclical secretory and menstrual response seen in the functionalis-derived tissue of endometriosis; the stroma is usually inactive, and secretory change or decidualisation is largely confined to pregnancy and progestin therapy. A minority of foci show proliferative or secretory change and may become cystic and haemorrhagic, which accounts for the inconstant T1-hyperintense foci seen on MRI. Adenomyosis is nonetheless oestrogen-dependent: the foci express steroid receptors and aromatase, exhibit progesterone resistance, and regress with GnRH analogues and aromatase inhibitors."
"uterine tumour (e.g. uterine leiomyosarcoma)"