Is There a Place for UAE in Adenomyosis?
Adenomyosis is a benign invasion of endometrium into the myometrium that results in a diffusely enlarged uterus that microscopically exhibits ectopic non-neoplastic endometrial glands and stroma surrounded by the hypertrophic and hyperplastic myometrium.
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Contents
Abstract
1
Introduction.......................................................................... 159
2
Diagnostic Imaging and Fundamental Radiological Signs ...................................................................................... 160
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Treatment Options .............................................................. 3.1 Medical Treatment........................................................ 3.2 Surgery .......................................................................... 3.3 MRI-Guided ‘High-Intensity Focused Ultrasound’..... 3.4 Embolization .................................................................
161 161 161 162 162
4
Embolization in Adenomyosis ............................................ 4.1 Uterine Artery Embolization Procedure ...................... 4.2 Results of Embolization in Adenomyosis ................... 4.3 UAE Results in Pure Adenomyosis............................. 4.4 UAE Results in Adenomyosis with Fibroids .............. 4.5 Additional Therapy and Complications after Embolization ........................................................ 4.6 Imaging Findings after UAE in Adenomyosis with or Without Fibroids..............................................
162 162 164 164 164
5
1
Introduction
164 164
To conclude .......................................................................... 165
References...................................................................................... 165
P. N. M. Lohle (&) Interventional radiologist, Department of Radiology, St. Elisabeth Ziekenhuis, Hilvarenbeekse Weg 60, 5022 GC, Tilburg, The Netherlands e-mail: [email protected]
Adenomyosis is a benign invasion of endometrium into the myometrium that results in a diffusely enlarged uterus that microscopically exhibits ectopic non-neoplastic endometrial glands and stroma surrounded by the hypertrophic and hyperplastic myometrium. This benign disease has either a focal or diffuse distribution in the uterine wall. Between 60 and 80 % of women with adenomyosis have coexisting pelvic localisations of the disease. Adenomyosis may occur alone, but is more frequently accompanied by fibroids in up to 55 % of cases.
Adenomyosis is a benign invasion of endometrium into the myometrium that results in a diffusely enlarged uterus that microscopically exhibits ectopic non-neoplastic endometrial glands and stroma surrounded by the hypertrophic and hyperplastic myometrium (Fig. 1) (Bird et al. 1972; Benagiano and Brosens 2006). This benign disease has either a focal or diffuse distribution in the uterine wall. Between 60 and 80 % of women with adenomyosis have coexisting pelvic localisations of the disease. Adenomyosis may occur alone, but is more frequently accompanied by fibroids in up to 55 % of cases (Fig. 2) (Ferenczy 1998; Vercellini et al. 1993; Siskin et al. 2001). The clinical diagnosis is challenging, as the presenting symptoms overlap with common uterine disorders such as fibroids of the uterus (Azziz 1989; Vercellini et al. 1993). Adenomyosis is often underdia
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