Answer
Answer
On sonograms, the most common appearance of adenomyosis is areas of decreased echogenicity or heterogeneity in the myometrium (see the images below). Di Donato et al described the following parameters as main criteria in the diagnosis of adenomyosis by TVS [11] :
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Heterogeneous myometrium
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Hyperechoic or hypoechoic linear striation in the myometrium
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Myometrial anechoic lacunae or cysts
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Subendometrial microcysts
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Asymmetric myometrial thickening of the uterine wall
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Global uterine enlargement
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The question mark sign
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Thickening of the junctional zone
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Hyperechoic myometrial areas
Transvaginal sonogram of an enlarged uterus with a thickened posterior myometrium (arrows).
Sagittal transabdominal sonogram of an enlarged uterus with a thickened posterior myometrium (arrows).
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Media Gallery
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Transvaginal sonogram of an enlarged uterus with a thickened posterior myometrium (arrows).
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Sagittal transabdominal sonogram of an enlarged uterus with a thickened posterior myometrium (arrows).
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Sagittal magnetic resonance image of an enlarged uterus with a thickened posterior myometrium. T2-weighted image without gadolinium enhancement shows a widened junctional zone of 23 mm (arrows) and focal high signal intensity (arrowhead). Same patient as in Images 1 and 2.
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Transvaginal sagittal image of the uterus showing indistinct endometrial lining (long yellow arrow) with subcentimeter avascular cyst abutting the posterior endometrial lining (short yellow arrow). Courtesy of Christopher D Scheirey, MD.
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Sagittal T2-weighted MRI image (same patient as in previous image) without IV contrast showing a globular hypertrophied uterus (long red arrow) and tiny fluid collection about the endometrial lining, with the short red arrow pointing to the largest one. Courtesy of Christopher D Scheirey, MD.
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