High-resolution magnetic resonance imaging in the detection of subtle nuances of uterine adenomyosis in infertility

Introduction: Magnetic resonance imaging (MRI) is the current reference standard for noninvasive imaging of the pelvis. In patients with infertility potentially earmarked for in vitro fertilization/intracytoplasmic sperm injection procedures, the distinction between adenomyosis and its mimics is extremely vital. This article highlights the vital role of MRI in the detection of subtle nuances of adenomyosis in infertility and the key imaging features of its associated conditions and mimics. Materials and Methods: This is a retrospective Health Insurance Portability and Accountability Act compliant study. Inclusion criteria consisted of (a) clinically diagnosed cases of primary infertility; (b) suspicion of adenomyosis on transabdominal and transvaginal ultrasonography; (c) nonvisualization/obscuration of the junctional zone; (d) multiparametric MRI performed at 3 T. Exclusion criteria included (a) other causes of primary infertility including Mullerian ductal anomalies, ovulation factors, and, hormonal factors such as hypothalamic-pituitary axis abnormalities; (b) secondary infertility. We identified a cohort of 114 patients who underwent multiparametric pelvic MRI on a 3 T system between July 2011 and March 2017 at our institution to rule out adenomyosis as a cause of primary infertility. Results: A total of 38 of 114 patients were diagnosed with adenomyosis, with focal adenomyosis seen in 20 patients and diffuse adenomyosis in 18 patients. Isolated adenomyosis was seen in 10 patients, whereas 28 patients had adenomyosis in combination with other pelvic pathologies. Twelve patients had isolated junctional zone thickening without any other features of adenomyosis or deep pelvic endometriosis. Conclusions: Pelvic MRI is the reference standard for the noninvasive detection of the subtle nuances of uterine adenomyosis, and, its associations including deep pelvic endometriosis in patients with infertility.