Adenomyosis is a nonneoplastic condition, characterized by benign invasion of ectopic endometrium into the myometrium with
hyperplasia of adjacent smooth muscle. The common symptoms include
dysmenorrhea,
menorrhagia, and abnormal
uterine bleeding, but these do not allow diagnosis. Therefore, imaging plays an important role because establishment of the correct preoperative diagnosis is critical to avoid unnecessary intervention. Magnetic resonance (MR) imaging is a highly accurate noninvasive modality for diagnosis of
adenomyosis, differentiation of
adenomyosis from other gynecologic disorders, and planning of appropriate treatment. Although the typical MR imaging findings are well established,
adenomyosis actually varies widely in terms of histopathologic features (
adenomyosis with sparse glands), growth patterns (polypoid
adenomyoma, adenomyotic
cyst, and miniature uterus), responses to hormonal activity (
tamoxifen, decidual changes), and responses to treatment (
gonadotropin-releasing hormone agonist). The MR imaging findings of
adenomyosis occasionally mimic those of uterine
malignancy or
ovarian cancer. Furthermore,
malignancy occasionally develops in otherwise benign
adenomyosis. Pitfalls in diagnosis of
adenomyosis include myometrial contractions,
leiomyoma,
adenomatoid tumor,
metastases,
endometrial carcinoma, and
endometrial stromal sarcoma. Knowledge of the various appearances of
adenomyosis and the possible pitfalls in differential diagnosis help guide the determination of appropriate treatment options.