الفهرس 
ANATOMY OF FEMALE GENITAL TRACTOnly 14 pages are availabe for public view
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Abstract
Adenomyosis is a non neoplastic condition, characterized by benign invasion of ectopic endometrium into the myometrium with hyperplasia of adjacent smooth muscle. It is an important factor of infertility.
Transvaginal ultrasound is the natural first choice of image modality when investigating pelvic pain or menstrual disorders dysmenorrhea and / or menorrhagia).
The ultrasound findings of adenomyosis include : uterine enlargement and asymmetry of the anterior or posterior myometrial wall. The heterogeneous appearance of myometrium reflects the infiltrative process of islands of heterotropic endometrial tissue that may be focally or diffusely scattered throughout the myometrium and that are poorly demarcated from the surrounding myometrium.
The ultrasound is helpful to differentiate beween adenomyosis and other diseases which cause uterine enlargement such as fibroids, endometrial hyperplasia and endometrial carcinoma especially with the aid of color Doppler to examine the vascularity and of the three dimensional ultrasound.
The diagnosis of adenomyosis by sonohysterography depends on one or more of the following findings : asymmetric thickening and echotexture of the myometrium, fluid tracking from the endometrial cavity into myometrial cracks, myometrial cysts, appearance of air bubbles in the myometrium, and indistinct endometrial–myometrial junction.
Adenomyosis may be imaged with Hysterosalpingography HSG if nests of endometrial tissue connect to the uterine cavity. It appears as small diverticula extending into the myometrium with small outpouchings of the contrast material.
Computed tomography (CT) has poor diagnostic value due to similar images portrayed by foci and normal myometrium. It can suggest a diagnosis of adenomyosis based on uterine enlargement, thickened inner myometrium, and/or myometrial cysts.
Magnetic resonance (MR) imaging is a highly accurate non-invasive technique for the diagnosis of adenomyosis. MR imaging is helpful not only in diagnosis of the disease but also in monitoring the effect of hormonal treatment therapy and in predicting its therapeutic effect .Typical MR features include either diffuse or focal thickening of the junctional zone . The normal mean thickness of the junctional zone is 2-8 mm. When the junctional zone thickness is 12 mm or greater, this is diagnostic for diffuse adenomyosis.
Adenomyosis has homogeneous intermediate signal intensity on T1-weighted images which couldn’t be differentiated from the myometrium. On T2-weighted images focal adenomyosis appears as an ill defined lesion of low–signal-intensity that often gives the appearance of focal widening of the junctional zone. This hypointense area is smooth-muscle hyperplasia. Bright foci seen in the myometrium are islands of heterotopic endometrial tissue, cystic dilation of heterotopic glands, or hemorrhage.
On contrast enhanced fat suppressed MR images focal adenomyosis showing ill defined mass within the myometrium, while diffuse adenomyosis couldn’t be detected by contrast enhanced fat suppressed MR images due to obliteration of the margin of the thickened junctional zone.