| Part1: MRI and clinical characteristics of different subtypes of adenomyosisObjective To investigate the imaging characteristics and clinical differences of three different subtypes of adenomyosis based on magnetic resonance imaging.Methods The clinical,pathological and imaging data of symptomatic AM patients who underwent surgical treatment in the Department of Gynecology,General Hospital of Ningxia Medical University from June 2018 to December2022 were retrospectively analyzed.All patients underwent pelvic MRI examination before surgery.According to Kishi classification,AM was divided into three subtypes by observing the geographical location of AM lesions with endometrium,junctional zone and serosa on sagittal T2 weighted imaging,including intrinsic type Ⅰ,extrinsic type Ⅱ,and instramural type Ⅲ.The MRI and clinical characteristics of AM in the three subtypes were compared.Results(1)A total of 143 patients with AM were included in this study,including 84 cases of type Ⅰ,38 cases of type Ⅱand 21 cases of type Ⅲ.(2)Comparison of clinical data of AM patients: There were significant differences in age,number of pregnancies,history of uterine cavity manipulation,menstrual blooding volume and hemoglobin level among the three subtypes(P<0.05).Compared with type II and type III patients,type I patients had more number of pregnancies and history of uterine cavity manipulation,more menstrual blooding volume and lower hemoglobin.However,there was no significant difference in VAS score of dysmenorrhea among the three subtypes(P>0.05).(3)Comparison of MRI characteristics in AM patients: There were significant differences among the three subtypes in the location of lesions,uterine morphology,presence of hyperintense spots on T 1WI,signal intensity of the main body of lesions on T 2WI and presence of pelvic endometriosis(P<0.05).(4)MRI characteristics of AM patients were further compared between subgroups:Compared with type Ⅰ,type Ⅱ and type Ⅲ lesions were more localized and distributed in the posterior wall of uterus [26(31%)cases of type Ⅰ,33(86.8%)cases of type Ⅱ,13(61.9%)cases of type Ⅲ,respectively].Uterine shape was irregular enlargement;Compared with type Ⅱ and type Ⅲ,the rate of hypointense signal intensity in the main body of type Ⅰ was higher [72 cases(85.7%)of typeⅠ,21 cases(55.3%)of type Ⅱ and 13 cases(61.9%)of type Ⅲ,respectively].The frequency of hyperintense spots on T 1WI was higher in type Ⅱ than in type Ⅰand type Ⅲ [24(28.6%)cases of type Ⅰ,21(55.3%)cases of type Ⅱ,4(19.0%)cases of type Ⅲ,respectively],and most of them were associated with endometriosis[11(13.1%)cases of type Ⅰ,21(55.3%)cases of type Ⅱ,3(14.3%)cases of type Ⅲ,respectively].(5)The three subtypes of adenomyosis were moderately correlated with the location of the lesions,the signal intensity of the main lesions and the presence of endometriosis(Cramer ’s V=0.347,0.319 and 0.431,respectively).Conclusion(1)Adenomyosis classification is closely related to the clinical characteristics of the disease,type I patients than type II,III patients have more pregnancy times and uterine cavity operation history,and menstrual blooding volume is more,hemoglobin is lower,but in the severity of dysmenorrhea no difference was found.(2)Different subtypes of adenomyosis had different MR imaging characteristics.The main signal intensity of adenomyosis type Ⅰ was low signal intensity,adenomyosis type Ⅱ was associated with pelvic endometriosis,and ectopic endometrial islands were more likely to bleed.Part2: To analyze the short-term efficacy of uterine artery embolization in the treatment of symptomatic adenomyosisObjective To evaluate the efficacy and safety of uterine artery embolisation in the treatment of symptomatic adenomyosis.Methods A total of 15 patients with symptomatic AM treated with UAE in the Department of Radiology and Interventional,General Hospital of Ningxia Medical University from November 2020 to February 2022 were prospectively enrolled.All patients underwent pelvic MRI before surgery.With Moderate-severe dysmenorrhea and(or)menorrhagia were used as the main indicators to evaluate the symptoms of patients.Visual analogue scale and pictorial blood loss assessment chart were used to evaluate the degree of dysmenorrhea and menstrual blood volume before and after surgery.The clinical efficacy and complications were observed after operation.The patients were followed up for 1 year.The improvement of dysmenorrhea and menstrual blood volume were evaluated at 1,3,6,and 12 months after operation.The postoperative adverse reactions were also recorded.Results UAE was successfully performed in 15 patients(30 uterine arteries)with AM,and no ovarian artery was involved in blood supply.The rate of dysmenorrhea relief was 73.3%(11/15),80.0%(12/15),86.7%(13/15)and86.7%(13/15)at 1,3,6 and 12 months after operation,respectively.The effective remission rates of menstrual volume were 93.3%(14/15),93.3%(14/15),100.0%(15/15)and 100.0%(15/15),respectively.At 1,3,6 and 12 months after operation,the VAS score of dysmenorrhea and PBAC score of menstrual volume were 3(2,4)and(80.5± 14.6),3(2,3)and(79.5± 15.9),2(2,3)and(69.3± 17.0),2(2,3)and(70.7 ± 17.9),respectively.Both were lower than preoperative 7(6,7)and 177.7± 80.0.The VAS scores of dysmenorrhea at 1,3,6 and 12 months after operation were significantly different from those before operation(Z=-3.437,-3.314,-3.329,-3.329,P<0.01).The PBAC scores of menstrual volume at 1,3,6and 12 months after operation were significantly different from those at baseline(t=5.286,5.075,5.648,5.453,P < 0.01).One patient had a dysmenorrhea VAS score of 7 points at 3 months follwed-up evaluatin after surgery,and dysmenorrhea symptoms recurred,which was considered as UAE treatment failure.The two patients in this group had long-term amenorrhea after 15 months of extended follow-up.Two patients had abnormal vaginal bleeding 3 days after surgery,accompanied with mild-moderate pain,which lasted for 2 weeks and then relieved.The hormone level of one patient decreased 2 months after operation,and had night sweats and drynessheat symptoms,which were relieved after symptomatic treatment.No serious procedure-related adverse events occurred in any patients.Conclusion UAE is a safe and effective treatment for symptomatic AM with significant short-term efficacy and improvement of dysmenorrhea and menorrhagia. |
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