Background: The aim of this exhibit is to discuss the role of different imaging modalities in the assessment of intra-uterine adenomiosis, giving special attention to the technical supports, differential diagnosis and diagnostic pitfalls.
Methods and materials: Typical findings and doubtful signs of intra-uterine adenomiosis will be shown by a series of Isterosalpingography (ISG), Ultrasound (US) and Magnetic Resonance (MRI) pictures. The most frequent pathologies or physiological status mimicking an intra-uterine adenomiosis at ISG, US or MRI will be discussed focusing the Reader’s attention on the semeiotic signs addressing the correct diagnosis.
Results: Depending on the technique, the differential diagnosis includes endometritis, cervicitis, leyomiomas, cystic lesions, adenomatoid tumors. Among the imaging modalities, MRI is the most accurate in assessing intra-uterine foci of adenomiosis but the correct timing for MRI examination is mandatory.
Discussion: ISG, US and MRI are differently employed in the female infertility work-up. ISG is especially used for tubal patency and morphology, but it can also suggest an intra-uterine adenomiosis at preliminary uterine cavity evaluation. When adenomiosis is observed at ISG, this examination must always be integrated by US or MRI, especially when clinical features are mild. US trasvaginal modality, is often the first diagnostic step in the clinical suspect of intra-uterine adenomiosis. However, it need to be completed by MRI especially in doubtful focal adenomiosis or to exclude cervical endometriosis. MRI is the best diagnostic presidium which should always be perform in the clinical suspect of adenomiosis since the correct therapeutic planning is better.