Duration of dysmenorrhoea and extent of adenomyosis visualised by magnetic resonance imaging
Duration of dysmenorrhoea and extent of adenomyosis visualised by magnetic resonance imaging
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DOI：
10.1016/j.ejogrb.2007.01.015
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发表时间：
2008-04-01
影响因子：
2.6
通讯作者：
Kaufmann, M.
中科院分区：
文献类型：
--
作者：
Kissler, S.;Zangos, S.;Kaufmann, M.
目的：子宫T2加权成像显示子宫交界区(JZ)增大是子宫内膜异位症患者子宫腺肌症的主要诊断标准。本研究旨在利用磁共振成像(MRI)分析子宫腺肌病的程度，并将其与痛经持续时间相关联。研究设计：这是一项前瞻性研究，有70名主诉严重痛经的患者。40名患者(57%)以痛经为主要主诉，30名患者(43%)还伴有不孕症。I组(n=40)为痛经病程在1~10年的患者，11组(n=30)为病程超过11年的痛经患者。所有患者均行腹腔镜检查子宫内膜异位症的存在及程度，所有患者均行子宫T2加权成像，通过测量子宫交界区的大小来确定子宫腺肌病的程度。结果：在第一组中，21例(52.5%)患者MRI可检出子宫腺肌病，19例(47.5%)子宫腺肌症患者未发现子宫腺肌病的征象。11组中26例(87%)JZ明显增大，仅4例(13%)未见子宫腺肌病征象(P=0.04)。Ⅱ组JZ的平均厚度(11.07mm)明显大于I组(6.38mmp<；0.0001)。痛经病程超过i-i年的子宫内膜异位症中，子宫腺肌症的发生率为87%。结论：在深度浸润性子宫内膜异位症中，特定的部位与痛经有关。经常找不到。最近，子宫内膜异位症和子宫腺肌症被认为是由一种常见的子宫疾病引起的，即基底部子宫内膜脱位。我们的数据清楚地表明，子宫内膜异位症患者持续时间较长的痛经与子宫腺肌症显著相关。因此，MRI对子宫腺肌症的诊断应成为痛经和子宫内膜异位症的标准检查方法。持续时间较长的严重痛经应始终集中于子宫腺肌病。(C)2007爱思唯尔爱尔兰有限公司。保留所有权利。
Objective: Enlargement of the junctional zone (JZ) on T2-weighted resonance imaging of the uterus has recently been established as the major criterion for adenomyosis in patients with endometriosis. This study was conducted to analyse the extent of adenomyosis using magnetic resonance imaging (MRI) and relate it to the duration of dysmenorrhoea.Study design: This was a prospective study of 70 patients presenting with the complaint of severe dysmenorrhoea. Forty patients (57%) reported dysmenorrhoea as their major complaint and 30 patients (43%) suffered additionally from infertility. Group I (n = 40) consisted of patients with dysmenorrhoea of between I and 10 years' duration, group 11 (n = 30) consisted of patients with dysmenorrhoea of longer than 11 years' duration. All patients underwent laparoscopy to detect the presence and degree of endometriosis, and all patients underwent T2-weighted resonance imaging of the uterus to detect the extent of adenomyosis by measurement of the "junctional zone".Results: In group 1, adenomyosis could be detected via MRI in 21 patients (52.5%), while 19 patients (47.5%) showed no signs of adenomyosis. By contrast, in group 11 a distinct enlargement of the JZ, as the major radiological criterion of adenomyosis, could be observed in 26 patients (87%), while only 4 patients (13%) revealed no signs of adenomyosis (p = 0.04). The mean thickness of the JZ was significantly enlarged in group II (11.07 mm) compared with group I (6.38 mm; p < 0.0001). The prevalence of adenomyosis in endometriosis after dysmenorrhoea of more than I I years' duration was 87%.Conclusions: In deep infiltrating endometriosis, a correlation between a specific localisation and dysmenorrhoea. can often not be found. Recently, endometriosis and adenomyosis have been believed to result from a common uterine disease, the dislocation of the basal endometrium. Our data clearly show that dysmenorrhoea of long duration in patients who have had endometriosis for over a threshold value of I I years is significantly related to adenomyosis of the uterus. Hence, evaluation of adenomyosis using MRI should become a standard procedure in cases of dysmenorrhoea and endometriosis. Severe dysmenorrhoea of long duration should always focus clinical interest on adenomyosis of the uterus. (c) 2007 Elsevier Ireland Ltd. All rights reserved.