Value of MRI in Evaluating the Severity of Adenomyosis

REN Junfang; LÜ Jun; LI Jin; LIU Kai

doi:10.3969/j.issn.1004-437X.2025.15.006

Abstract：Objective To explore the value of magnetic resonance imaging(MRI)in evaluating severity of adenomyosis.Methods Pelvic MRI and clinical data from 93 patients with adenomyosis were retrospectively collected.Uterine volume on MRI,number of T2-weighted imaging(T2WI)hyperintense foci within lesions,dysmenorrhea scores,serum carbohydrate antigen 125(CA125)levels,and interleukin-6(IL-6)levels before and 3 days after uterine artery embolization were analyzed.Based on the positional relationship between adenomyotic lesions and adjacent structures on T2WI MRI,cases were classified into:Type Ⅰ(intrinsic,21 cases),Type Ⅱ(extrinsic,23 cases),Type Ⅲ(intramural,14 cases),and Type Ⅳ(other,35 cases).Differences and correlations between MRI features,clinical characteristics,and postoperative outcomes in adenomyosis patients were evaluated.Results(1)The uterine volume and the number of high-signal lesions on T2WI in patients with adenomyosis exhibited a positive correlation with CA125 levels and postoperative IL-6 levels(P＜0.05).(2)The analysis of uterine volume,the number of T2WI hyperintense signals,and CA125 levels among the four subtypes of adenomyosis demonstrated statistically significant differences(P＜0.05).Pairwise comparisons revealed that the differences in uterine volume,the number of T2WI hyperintense signals,and CA125 levels between Type Ⅰ and Type Ⅳ were statistically significant(P＜0.05),the difference in uterine volume between Type Ⅱ and Type Ⅳ was statistically significant(P＜0.05),and the difference in the number of high-signal lesions between Type Ⅲ and Type Ⅳ on T2 WI was statistically significant(P＜0.05).(3)Among the four subtypes of patients,the complete remission rate of dysmenorrhea in Type Ⅳ was lower than that in TypesⅠ,Ⅱ,and Ⅲ at six months postoperatively,with the difference being statistically significant(P＜0.05).(4)Postoperative uterine volume was significantly reduced across all four subtypes compared to preoperative measurements,with Type Ⅳdemonstrating a statistically significant greater reduction rate than Types Ⅰ,Ⅱ,and Ⅲ(P＜0.05).(5)There was a statistically significant difference in the degree of dysmenorrhea among patients grouped by different levels of IL-6(P＜0.05),however,no statistically significant differences were observed in uterine volume,number of T2WI hyperintense lesions,or CA125 levels among patients stratified by different levels of IL-6(P＞0.05).Conclusion MRI findings of adenomyosis may be related to the severity of adenomyosis and postoperative efficacy,which can help clinicians better understand the condition and guide clinical decision-making.