Enlarged uterus: differentiation between adenomyosis and leiomyoma with MR imaging.

TLDR

The study evaluated the use of magnetic resonance imaging to differentiate adenomyosis from leiomyoma in 93 patients with a palpable enlarged uterus. MR images were correlated with surgical and pathological findings in all cases. MR imaging correctly identified the cause of uterine enlargement in 92 of 93 cases, distinguishing adenomyosis (16 cases) from leiomyoma (71 cases, including one leiomyosarcoma) and detecting simultaneous involvement in six patients.

Abstract

The potential of magnetic resonance (MR) imaging in differentiation of adenomyosis from leiomyoma was evaluated in 93 patients who had a palpable enlarged uterus that was suspect for leiomyoma or adenomyosis. In all cases, MR images were correlated with surgical/pathologic findings. Pathologic findings showed that 71 enlarged uteri were due to leiomyoma, including one leiomyosarcoma, and 16 were due to adenomyosis. The other six patients were shown to have an enlarged uterus attributable to simultaneous involvement of both lesions. On T2-weighted images, adenomyosis appeared as an ill-defined, relatively homogeneous low-signal-intensity area embedded with sparse high-intensity spots. In contrast, leiomyomas were well-circumscribed masses with a spectrum of signal intensity. The cause of uterine enlargement was correctly diagnosed with MR images in 92 of the 93 cases. It is concluded that MR imaging is highly accurate in helping to distinguish between adenomyosis and leiomyoma in cases of enlarged uterus.