Junctional Zone Thickness Research Articles

Evaluation of junctional zone differential and ratio as possible markers of clinical efficacy in uterine artery embolisation of adenomyosis

BackgroundUterine artery embolisation is a recommended method of adenomyosis treatment with good clinical results. Changes in uterine volume and maximal junctional zone thickness (JZmax) after embolisation are thoroughly analyzed in the literature. In contrast changes in other suggested morphological diagnostic markers of adenomyosis (junctional zone differential / JZdiff—and junctional zone ratio / JZratio) are rarely evaluated. This single-centre retrospective study aimed to analyse the changes in morphological parameters used for the MR imaging diagnosis of adenomyosis (including JZdiff and JZratio) after UAE. Clinical effectiveness and safety were also analysed.Materials and methodsPatients who underwent UAE for pure adenomyosis from Jan 2008 to Dec 2021 were evaluated. Adenomyosis was diagnosed based on JZmax, JZdiff, and JZratio measured on MR imaging. To assess clinical efficacy, the numerical-analog-quality-of-life (QoL) score was routinely obtained from patients at our centre. MRI morphological data were analysed. Statistical analysis was conducted using Wilcoxon signed-rank test, uni- and multivariate regression models, Pearson product-moment correlation, and Kruskal–Wallis tests.ResultsFrom our database of 801 patients who underwent UAE between Jan 2008 to Dec 2021, preprocedural MR images were available in 577 cases and, 15 patients had pure adenomyosis (15/577, 2.6%). Uterine volume, JZmax, and JZdiff decreased significantly after UAE; QoL score increased significantly. A significant correlation was found between QoL change vs. JZmax and JZdiff change. Permanent amenorrhoea and elective hysterectomy 5 years after UAE were both 7.1%.ConclusionChange of JZdiff after UAE in adenomyosis is a potential marker of clinical success. UAE is a clinically safe and effective treatment for adenomyosis.Graphical

Diagnostic Role of Transvaginal Sonography and Magnetic Resonance Imaging in Adenomyosis of the Uterus and its Correlation with Histopathology.

The prevalence of adenomyosis of the uterus varies from 5% to 70%, and there is no clear consensus on its imaging diagnostic criteria. The objective of this study was to evaluate the role of transvaginal sonography (TVS), combined TVS and color Doppler (TVS-CD), and magnetic resonance imaging (MRI) in the diagnosis of adenomyosis. This was a tertiary care hospital-based prospective study, in which 365 clinically suspected cases of adenomyosis were enrolled. All three types of imaging (TVS, TVS-CD, and MRI) were done in 233/365 patients, followed by hysterectomy in 50. Imaging features were correlated with the histopathological examination (HPE), which was taken as the gold standard for the diagnosis. The diagnostic performance of each imaging modality was assessed. Among patients who underwent hysterectomy, 36/50 (72%) had adenomyosis on HPE, with or without associated benign gynecological abnormalities. Sensitivity, specificity, positive predictive value (PPV), negative PV (NPV), and diagnostic accuracy (DA) of MRI were higher than that of TVS-CD (91.67% vs. 77.78%, 85.71% vs. 78.57%, 94.29% vs. 90.32%, 80% vs. 57.89%, and 90% vs. 78%, respectively). TVS alone had lower diagnostic performance (specificity: 64.29%, PPV 84.85%, NPV 52.94%, and DA74%) than TVS-CD, but equal sensitivity (77.78%). Heterogeneous myometrium was the most sensitive (80.56%), while myometrial cyst was the most specific (92.86%) TVS feature. The maximum junctional zone thickness ≥12 mm was the most sensitive (97.22%), while the hyperintense myometrial focus was the most specific (100%) MRI feature. TVS-CD should be used as an initial diagnostic imaging modality in clinically suspected cases of adenomyosis; however, MRI due to better diagnostic efficacy should be the imaging modality of choice before subjecting such patients to hysterectomy.

Is there a relationship between adenomyosis and nabothian cyst?

PurposeThe aim of this study was to investigate whether there is a relationship between adenomyosis and nabothian cyst (NC) in a large patient series.Material and methodsThe patient’s data were scanned retrospectively and patients with a junctional zone thickness of 12 mm and above on magnetic resonance imaging were accepted as group adenomyosis (group A). Patients with a junctional zone thickness of less than 12 mm were not admitted as adenomyosis (control group). Both groups were compared for NC.ResultsIn group A, 176 (69.8%) patients had NC (n = 250), while in the control group (n = 202), 57 (28.2%) patients had NC. NC was significantly higher in group A than in the control group (p < 0.001).ConclusionsThe aetiology of NC is still unclear. According to our results, similar factors may affect adenomyosis and NC aetiopathogenesis.

Comprehensive method of ultrasound diagnosis of adenomyosis

BACKGROUND: There are currently no uniform standards for adenomyosis diagnosis, so the search for the most informative methods is an urgent task. This article presents modern views on the diagnosis of adenomyosis and the role of ultrasound in its diagnostics.&#x0D; AIM: The aim of this study was to determine the diagnostic capabilities of ultrasound in the diffuse form of adenomyosis.&#x0D; MATERIALS AND METHODS: This study included 164 patients aged 22 to 43 years old, who had a comprehensive ultrasound examination done. The points were calculated and the presence or absence of adenomyosis, as well as its severity, were determined using the developed scale. The sequential implementation of six ultrasound techniques were used for a comprehensive ultrasound assessment of adenomyosis: assessment of the myometrium echostructure homogeneity; assessment of the ratio of the anterior and posterior uterine wall thicknesses; compression elastography; assessment of the junctional zone in the 3D mode; assessment of the uniformity of the junctional zone thickness along uterine walls; vascularization of the myometrium in the Power Doppler 3D Glass Body mode.&#x0D; RESULTS: We have developed the comprehensive ultrasound method of adenomyosis diagnostics. The sensitivity of the method was 95%, and the specificity was 100%. The positive predictive value was 100%, and the negative predictive value was 90%. The accuracy of the method was 97%.&#x0D; CONCLUSIONS: The developed scoring system for the comprehensive assessment of adenomyosis allows for an independent assessment of the myometrium for each criterion, summarizing the scores and, therefore, assessing the presence and severity of adenomyosis more objectively and reliably. The high sensitivity and specificity of this technique allows recommending it for use by ultrasound specialists.

Uterine Adenomyosis Treated by Linzagolix, an Oral Gonadotropin-Releasing Hormone Receptor Antagonist: A Pilot Study with a New ’Hit Hard First and then Maintain’ Regimen of Administration

(1) Background: The aim of the present pilot study was to study the effect of a new oral gonadotropin-releasing hormone antagonist on adenomyosis. (2) Methods: Eight premenopausal women, aged between 37 and 45 years, presenting with heavy menstrual bleeding, pelvic pain, and dysmenorrhea due to diffuse and disseminated uterine adenomyosis, confirmed by magnetic resonance imaging (MRI), received 200 mg linzagolix once daily for a period of 12 weeks, after which they were switched to 100 mg linzagolix once daily for another 12 weeks. The primary efficacy endpoint was the change in volume of the adenomyotic uterus from baseline to 24 weeks, evaluated by MRI. Secondary efficacy endpoints included the change in uterine volume from baseline to 12 and 36 weeks by MRI, and also weeks 12, 24, and 36 assessed by transvaginal ultrasound (TVUS). Other endpoints were overall pelvic pain, dysmenorrhea, non-menstrual pelvic pain, dyspareunia, amenorrhea, quality of life measures, bone mineral density (BMD), junctional zone thickness, and serum estradiol values. (3) Results: Median serum estradiol was suppressed below 20 pg/mL during the 12 weeks on linzagolix 200 mg, and maintained below 60 pg/mL during the second 12 weeks on linzagolix 100 mg. At baseline, the mean ± SD uterine volume was 333 ± 250 cm3. After 24 weeks of treatment, it was 204 ± 126 cm3, a reduction of 32% (p = 0.0057). After 12 weeks, the mean uterine volume was 159 ± 95 cm3, a reduction of 55% from baseline (p = 0.0001). A similar pattern was observed when uterine volume was assessed by TVUS. Improvements in overall pelvic pain, dysmenorrhea, non-menstrual pelvic pain, dyspareunia, and dyschezia, as well as quality of life measured using the EHP-30 were also observed. Mean percentage BMD loss at 24 weeks was, respectively, −2.4%, −1.3%, and −4.1% for the spine, femoral neck, and total hip. The most common adverse events were hot flushes, which occurred in 6/8 women during the first 12 weeks, and 1/8 women between 12 and 24 weeks. (4) Conclusions: Linzagolix at a dose of 200 mg/day reduced uterine volume, and improved clinically relevant symptoms. Treatment with 100 mg thereafter retains the therapeutic benefits of the starting dose while minimizing side effects. This ‘hit hard first and then maintain’ approach may be the optimal way to treat women with symptomatic adenomyosis.

Role of biometric characteristics of the uterine junctional zone in fertility outcomes in patients with adenomyosis

BACKGROUND: The uterine junctional zone is the inner part of the myometrium. Dysfunction of the zone may underlie the pathogenesis of adenomyosis and its clinical manifestations, while biometric characteristics of the zone are currently considered as promising early diagnostic criteria for this disease. Adenomyosis has traditionally been associated with parity and intrauterine interventions, primarily in older patients. However, modern imaging tools often allow diagnosing the disease in young patients with infertility and an unburdened gynecological history. It is assumed that the detection of changes in the structure and function of the uterine junctional zone in adenomyosis can be the basis for predicting fertility outcomes and complications of pregnancy, as well as for the development of promising therapeutic strategies at the pregravid stage.&#x0D; AIM: The aim of this study was to assess the influence of biometric characteristics of the uterine junctional zone on pregnancy outcomes, depending on the parity and intrauterine interventions in patients with adenomyosis.&#x0D; MATERIALS AND METHODS: This prospective study included 102 patients aged 2239 years old with ultrasound features of adenomyosis who were going to conceive. The patients were divided into two groups: Group 1 (n = 58) consisted of nulliparous patients with no history of previous intrauterine interventions, and Group 2 (n = 44) comprised multipara women with a history of labor and / or intrauterine interventions. Using magnetic resonance imaging, we evaluated minimal, average and maximal junctional zone thicknesses, junctional zone deferential and a ratio of junctional zone thickness to myometrium thickness. Thresholds of biometric characteristics of the uterine junctional zone for adverse pregnancy outcomes were estimated.&#x0D; RESULTS: The frequencies of pregnancy and retrochorial hematoma in patients of Groups 1 and 2 in the first trimester of pregnancy did not differ significantly and amounted to 43.1% and 38.6%, 13.8% and 22.7%, respectively, p 0.05. Adverse pregnancy outcomes were diagnosed in 63.8% of patients in Group 1 and in 68.2% of patients in Group 2, p 0.05. In Group 1, the frequency of retrochorial hematoma depended on the initial junctional zone deferential, as well as on the initial average and maximal junctional zone thicknesses, junctional zone deferentials and ratios of junctional zone thickness to myometrium thickness, which, with an adverse pregnancy outcome, were 1.72.5 times higher than those in patients with a favorable outcome, p 0.05. In Group 2, adverse pregnancy outcomes were recorded with significantly higher values of average and maximal junctional zone thicknesses and junctional zone deferential. ROC curves were constructed using data of logistic regression analysis based on biometric characteristics of the uterine junctional zone to predict spontaneous abortion and infertility in patients with adenomyosis.&#x0D; CONCLUSIONS: Fertility outcomes in patients with adenomyosis depend on a complex of biometric characteristics of the uterine junctional zone as determined by magnetic resonance imaging.

O-146 Assessment of focal and diffuse adenomyosis lesions before and after pregnancy on magnetic resonance imaging : a cohort of 139 patients

Abstract Study question How to assess the different adenomyosis phenotype before and after pregnancy on magnetic resonance imaging according to stringent validated criteria ? Summary answer Diffuse adenomyosis increases significantly after pregnancy while the rate of focal adenomyosis and the mean volume of focal adenomyosis lesions decrease significantly after pregnancy. What is known already Adenomyosis and endometriosis are benign hormone-dependent disorders associated with pelvic pain, dysmenorrhea and/or infertility. The natural course of adenomyosis and endometriosis is still unclear, particularly during pregnancy. Pregnancy is considered to have a positive impact on endometriosis. Several studies regarding the impact of adenomyosis on pregnancy are available. Adenomyosis can cause fertility disorders, miscarriage, preterm birth. However, available data evaluating the effect of pregnancy on adenomyosis are lacking. Study design, size, duration Between January 1st 2010 and September 30th 2020, 139 patients were followed in our referral care center (Gynecology department of Port-Royal Hospital, Paris) for symptomatic adenomyosis and or endometriosis. For each of them, a magnetic resonance imaging were performed before and after pregnancy. The data based on magnetic resonance imaging, pre- and post-pregnancy, were analyzed in a single retrospective study. Participants/materials, setting, methods Patients had to be over 18 years old, to be pregnant and to be followed for symptomatic adenomyosis or endometriosis without any previous surgery. Each pelvic magnetic resonance imaging were performed by a single experienced radiologist. The protocol was identical on a 1.5 T magnetic resonance imaging machine based on validated criteria. The rate of diffuse and focal adenomyosis, the volume of focal adenomyosis lesions and the thickness of maximal junctional zone were reported. Main results and the role of chance The mean age of patients was 34.6 ± 3.4 years old, 83 (59.7%) of patients underwent assisted reproductive technology to be pregnant. The mean time interval between the MRI and the delivery was 55.2 months and the mean time interval between the delivery and the MRI was 32.2 months. Before pregnancy, there was 96 (69.1%) patients with adenomyosis, all phenotype combined versus 111 (79.9%) after pregnancy (p = 0.04) on magnetic resonance imaging. The rate of diffuse adenomyosis increased significantly on magnetic resonance imaging after pregnancy compared to before pregnancy (n = 22 (15.8%) vs n = 41 (29.5%), p = 0.01). The thickness of junctional zone maximal was significantly higher after pregnancy (8.0 mm ± 5.1 vs 12.0 mm ± 4.8, p &amp;lt; 0.01). The rate of focal adenomyosis (n = 55 (39.6) vs n = 34 (24.5), p = 0.01) as well as the volume of focal adenomyosis lesions (6.7 mm3 2.5± vs 6.4 mm3 ± 2.3, p &amp;lt; 0.01) decreased significantly after pregnancy on magnetic resonance imaging. Limitations, reasons for caution This single-center study was conducted in a referral center whom patients presented more severe forms of adenomyosis, which could have affected the external validity of this study. The mean time interval between delivery and MRI was 32.2 month which implies a short follow up period to observe long term outcomes. Wider implications of the findings The hypothesis that a specific hormonal environment during pregnancy may imply a positively impact of the evolution of focal adenomyosis is raised by this study. The evolution of focal adenomyosis after pregnancy is similar to the evolution of endometriosis lesions volume that support shared etiopathogenic mechanisms between the two entities. Trial registration number ‘not applicable’

The role of uterine artery embolization in management of abnormal uterine bleeding

Background:Abnormal uterine bleeding is a common presenting symptom in the family practice setting. The most common causes are uterine fibroids, dysfunctional uterine bleeding and adenomyosis. All conditions were accompanied by chronic blood loss disabling normal lifestyle with variable degrees of morbidity. Objectives: This study is aiming to evaluate the safety, efficacy, and complications of uterine artery embolization(UAE) in the management of abnormal uterine bleeding (AUB)in different age groups. Patients and Methods: This a prospective randomized clinical trial prospective study included 20 patients referred for UAE. Twelve patients had uterine fibroids, 4 patients had adenomyosis and other 4 patients were diagnosed as dysfunctional uterine bleeding. The embolizing materials were used includingPolyvinyl alcohol, Tris- acryl gelatin microspheresand gelatin sponge. All patients had AUB. Results: Most patients showed good therapeutic responses through the follow up period (6-12 months). Complete control of bleeding was achieved in 90% of patients and recurrence occurred only in 10%. There was complete improvement of the pelvic pain and bulk related symptoms. Reduction of uterine and fibroid size occurred with average uterine and dominant fibroid volumes loss of 39%, and 57% respectively. However, the reduction in the Junctional zone thickness was 5.6 %. Conclusion: UAE is considered minimally invasive, safe, and effective method that plays an important role in treatment of variable types of AUB causes, aiming for uterine preservation and avoiding hysterectomy giving the chance for future fertility. It has high success rate with obvious low morbidity and mortality rates.

Initial Experience With Diffusion-Weighted Magnetic Resonance Imaging for the Evaluation of Endometrial Fibrosis.

This study aimed to determine the feasibility of diffusion-weighted imaging for detecting endometrial fibrosis in patients with intrauterine injury. This prospective study included 34 patients with endometrial fibrosis and 34 healthy controls. All participants underwent T2-weighted and diffusion-weighted magnetic resonance imaging with b values of 0 and 1000 s/mm2 during the periovulatory phase with a dominant follicle. The endometrial apparent diffusion coefficient (ADC) and uterine anatomical parameters (endometrial thickness [EMT], length of the uterine cavity [LUC], and junctional zone thickness [JZT]) were measured and compared. Performance of the uterine endometrial ADC and anatomical parameters in diagnosing endometrial fibrosis was evaluated. Patients with endometrial fibrosis showed a lower endometrial ADC, lower EMT, shorter LUC, and higher JZT than did healthy controls (all, P < 0.001). Endometrial ADC value and uterine anatomical parameters showed good performance in diagnosing endometrial fibrosis, with the areas under the receiver operating characteristic curves of 0.976, 0.870, 0.883, and 0.864, respectively. The area under the curve of ADC was significantly higher than those of EMT (z = 1.973, P = 0.0485), LUC (z = 2.059, P = 0.0395), and JZT (z = 2.484, P = 0.0130). Intraobserver and interobserver agreements of endometrial ADC value measurements were excellent for both patients (intraclass correlation coefficient = 0.987 and 0.983, respectively) and healthy women (intraclass correlation coefficient = 0.986 and 0.989, respectively). Our preliminary results suggest that diffusion-weighted imaging has the potential to be a noninvasive imaging tool for the quantitative assessment of endometrial fibrosis.

A rare case of extensive placenta accreta in twin pregnancy after GnRH agonist treatment of adenomyosis

BackgroundAdenomyosis remains an enigma for the reproductive endocrinologist. It is thought to contribute to sub-fertility, and its only curative treatment is hysterectomy. However, studies have documented increased live birth rates in women with adenomyosis who were treated with gonadotropin releasing hormone agonist (GnRHa).CaseHere we present a case of a 52-year-old woman with adenomyosis who had three failed frozen embryo transfers (FETs) prior to initiating a 6-month trial of GnRHa. GnRHa therapy resulted in a decrease in uterine size from 11.5 × 7.9 × 7.0 cm to 7.8 × 6.2 × 5.9 cm and a decrease in the junctional zone (JZ) thickness from 19 to 9 mm. Subsequently, she underwent her fourth FET, which resulted in live birth of twins. The delivery was complicated by expansive accretas of both placentas requiring cesarean hysterectomy. The final pathology of the placentas demonstrated an extensive lack of decidualized endometrium that was even absent outside the basal plate.ConclusionsGnRHa therapy in patients with adenomyosis may improve implantation rates after FET. Previous molecular studies indicate that genetic variance in the expression of the gonadotropin releasing hormone receptor (GnRHR) could explain the expansive lack of decidualized endometrium after GnRHa therapy. Further investigations are needed to determine if GnRHa therapy contributes to the pathologic process of placenta accreta.

Аденомиоз и бесплодие. Подходы к лечению

Aim: to improve the rate of pregnancy in women with adenomyosis and infertility. Patients and Methods: this prospective comparative study included 150 women aged 24–38 years. Among them, 120 women were diagnosed with infertility and adenomyosis, and 30 healthy women planned pregnancy (control group). 60 women (study group 1) underwent surgery for adenomyosis, 30 women were followed up only (study subgroup 1A) and 30 women received Dienogest 2 mg for 6 months (study subgroup 1B). Women of study group 2 (n =60) underwent no surgery, 30 women were followed up only (study subgroup 2A) and 30 women received Dienogest 2 mg for 6 months (study subgroup 2B). After 3 and 6 months, blood levels of hormones, junctional zone thickness (measured by ultrasound), and the rate and time of pregnancy were assessed. Results: at baseline, women with adenomyosis were reported to have high levels of estradiol (p&lt;0.05 compared to the control group). After 3 and 6 months, the level of estradiol gradually reduced to 432.5±27.4 pmole/l and 364.3±16.2 pmole/l in study subgroup 2A and 314.3±22.7 pmole/l and 264.7±18.6 pmole/l in study subgroup 2B (p&lt;0.05). Pregnancy occurred, on average, after 6.1±1.6 (3–8) months in study subgroup 1A, 5.3±1.1 (4–7) months in study subgroup 2A, 4.1±1.4 (2–7) months in study subgroup 1B (p≤0.05 compared to study subgroup 1A and study group 2), and 5.1±1.2 (3–7) months in study subgroup 2B. In study groups 1 and 2, pregnancy occurred 1.5- and 1.4-times more commonly in women who received Dienogest. Conclusions: surgery and further hormone therapy is an optimal management strategy for adenomyosis and infertility. KEYWORDS: adenomyosis, infertility, Dienogest, junctional zone, pregnancy. FOR CITATION: Esedova A.E., Medzhidova A.M. Adenomyosis and infertility. Management strategies. Russian Journal of Woman and Child Health. 2021;4(2):110–114. DOI: 10.32364/2618-8430-2021-4-2-110-114.

Diagnosing adenomyosis with MRI: a prospective study revisiting the junctional zone thickness cutoff of 12mm as a diagnostic marker.

To assess the diagnostic accuracy of a junctional zone (JZ) thickness of ≥ 12mm and morphological features of the JZ in MRI in diagnosing adenomyosis in a premenopausal study population. This single-center, prospective observational study consecutively enrolled 93 premenopausal women suffering from a benign gynecological condition, from September 2014 to August 2016. Institutional review board approval and written consent were obtained. All participants underwent MRI and hysterectomy with a histopathological examination. MR images were evaluated in a blinded fashion by two independent readers. The maximum junctional zone thickness (JZmax), presence of JZmax ≥ 12mm, and any irregular appearance of the JZ (defined as irregular outer or inner borders, focal thickening, presence of high-intensity signal foci, or fingerlike indentations at the inner border) were documented, and the diagnostic performance was evaluated with the AUC, chi-square test, and multiple regression. Adenomyosis was histopathologically confirmed in 57 (61%) of the women. JZmax was not positively correlated with adenomyosis diagnosis (AUC = 0.57, p = 0.26) and did not differ significantly between those with and without adenomyosis (10.3 vs 10.1mm, p = 0.88), nor was a cutoff of JZmax ≥ 12mm (n = 30/57 (53%) vs n = 16/36 (44%), p = 0.29). The presence of an irregular JZ showed the best association with adenomyosis among the evaluated signs (sensitivity 74% (95% CI, 60, 85); specificity 83% (95% CI, 67, 94) (p < 0.001)). JZmax was not correlated with adenomyosis in the present premenopausal study population, but direct signs of adenomyosis such as irregularities of the JZ provided a good diagnostic accuracy. • Measuring the junctional zone thickness is of limited value for diagnosing adenomyosis with MRI and should not be used for diagnosing adenomyosis in premenopausal women with moderate disease severity. • An irregular appearance of the junctional zone, the presence of myometrial cysts, and adenomyoma appear to provide the highest specificity for diagnosing adenomyosis. • A consensus for the definition and reading of the junctional zone is needed.

EP16.01: Predictive value of junctional zone thickness and 3‐dimensional uterine power Doppler in recurrent unexplained pregnancy loss: a new diagnostic tool

EP16.01: Predictive value of junctional zone thickness and 3‐dimensional uterine power Doppler in recurrent unexplained pregnancy loss: a new diagnostic tool

A clinical audit on the efficacy and safety of uterine artery embolisation for symptomatic adenomyosis: Results in 117 women.

Uterine artery embolisation (UAE) is a possible uterine-sparing treatment option for women with unsuccessful conservative management for adenomyosis-related heavy menstrual bleeding (HMB) and dysmenorrhoea. To conduct a clinical audit on the efficacy and safety of UAE for symptomatic adenomyosis. Retrospective review of 309 women who underwent UAE identified 117 women with magnetic resonance imaging features of adenomyosis (junctional zone thickness ≥12mm). Overall success and HMB control were rated by women. Visual analogue scale (VAS) pain score, Uterine Fibroid Symptom and health-related Quality of Life (UFS-QoL) symptoms score and quality of life score were also used to measure outcome. One hundred and fifteen women (98%) were available for outcome evaluation. The mean follow-up was 22.5months. Overall clinical success was achieved in 102/115 (89%) women; HMB control was achieved in 91/104 (88%); dysmenorrhea relief was achieved in 94/104 (90%), with VAS reduction of 6.13 (P<0.001), Mean symptoms score was reduced from 58 to 17 at 12months (P<0.001) and QoL score increased from 42 to 88 at 12months (P<0.001). Hysterectomy was performed on six (5%) women. There were three (3%) mild groin haematomatas and three (3%) mild subacute complications (one possible endometritis, two urinary tract infections; all responded to oral antibiotics). Two women had unintended pregnancies which were complicated. In this clinical audit UAE was found to be an effective uterine-sparing option for women who had unsuccessful conservative treatments for adenomyosis-related HMB and dysmenorrhoea. There were no major complications. Two women had unintended pregnancies that were complicated.

3D ultrasound assessment of endometrial junctional zone anatomy as a predictor of the outcome of ICSI cycles

ObjectiveTo study the relation between junctional zone thickness (JZ) and success of implantation in IVF/ICSI cycles. Study designA prospective study included 100 infertility patients undergoing ICSI. The long protocol was used in all patients. JZ was measured using 3D ultrasound, in the coronal section, at three places, on two occasions. First measurement was done before HMG was started (i.e. when down regulation was achieved). Second measurement was done on the day of ovum pick up (OPU). Follow up after treatment was done to determine the rate of implantation. ResultsThere was a highly significant difference between pregnant and non pregnant treated women regarding the measurement of JZ at the day of OPU at all sites named fundal (0.27±0.1 vs. 0.38±0.14), anterior (0.28±0.07 vs. 0.36±0.09), posterior (0.32±0.1 vs. 0.37±0.09) and average (0.29±0.08 vs. 0.37±0.09) respectively.The cut off value, sensitivity and specificity of measurement of JZ at fundus were (≤0.31,90% and 66.7%), at anterior wall were (≤0.35,90% and 60%), at posterior wall (≤0.25, 50% and 93.3%) and average were (≤0.32,70% and 70%) respectively. ConclusionThe thinner the junctional zone at day of OPU, the higher the implantation rate and the difference between JZ measured at the day of down regulation and the day of OPU is a predictor of the outcome of ICSI cycles.

Differential effects of chronic iron deficiency anaemia on junctional and labyrinthine zones of placenta in Sprague dawely rat

Iron deficiency anaemia causes adverse pregnancy outcome. Studies reveal its generalized effects on histomorphometry of the placenta, without details on specific zones nor effect of gestational age. These data are important for planning intervention. This study was, therefore, designed to describe the histomorphometric changes associated with iron deficiency anaemia on placenta of albino rat. Fourty nine (49) Sprague – Dawely albino rats were randomly separated into experimental and control groups. The experimental group was rendered anaemic by removing 1.5 ml of blood per bleed on five alternate days. Placentas were collected on gestational days 17, 19 and 21. Five cubic milimetre segments were fixed in 10 % buffered formaldehyde solution; dehydrated in ethanol and embedded in paraffin wax. Five micron thick sections were cut, deparaffinized and stained with Hematoxylin and Eosin. Micrographs were taken using Leica ICC 50 digital photomicrographic camera attached to a computer at magnification x40 and the thickness of the labyrinth and junctional zones measured. Student t- test was used to compare values for the experimental and control groups. The labyrinth in the chronic anaemia group was thinner than in the control group at gestational days 17, 19 and 21. The junctional zone, on the other hand, was consistently thicker in anaemic than in the control animals. The difference in thickness of junctional zone varied with gestational age. At gestational day 17, the zone was significantly thicker in the anaemic group (628.9 μ) than in the control (381 μ). On day 19 and 21, however, the difference was not statistically significant. In conclusion, the effects of chronic iron deficiency anaemia on the labyrinth differ from those on the junctional zone of the placenta. This differential effect appears to depend on the function and gestational age. The decrease in thickness of the labyrinth may be designed to maintain placental diffusion capacity while increased thickness of the junctional zone constitutes a compensatory physical and nutritional adaptation to hypoxia.Key words: placenta, labyrinthine, junctional zones, thickness, anaemia.

Preimplantation 3D ultrasound: current uses and challenges.

The preimplantation ultrasound (US) refers to targeted imaging of the uterus and adnexa prior to assisted reproductive techniques (ART) to optimize the infertility treatment outcomes. After a thorough evidence based literature review, we propose the use of transvaginal three-dimensional (3D) US during the early follicular phase. A systematic approach for 3D US examination consists of a detailed examination of the uterine shape, size and contour, evaluation of the endometrial thickness, volume, pattern and vascularity, and assessment of the junctional zone regularity, echogenicity and thickness. Uterine anatomy is explored in the coronal plane by simultaneous visualization of the uterine cavity, the external surface of the fundus and cervix. Saline infusion sonogram (SIS) is recommended for patients with increased endometrial volume, abnormal endometrial pattern and irregular uterine cavity shape suggestive of Müllerian duct anomalies or acquired intracavitary abnormalities. Myometrial lesions should be recognized and proper dimensions and locations should be ascertained. Ovarian dimensions and volume are measured and the antral follicle count is recorded. Adnexa are carefully assessed for masses, endometriosis and dilated tubes. Color power Doppler US may be applied to evaluate vascularity of the ovaries and pelvic lesions. Hysterosalpingo-contrast-sonography (Hy-Co-Sy) should be optimally utilized for assessment of tubal patency. Accessibility and mobility of the ovaries should be checked in real time for better planning of the ultrasound-guided oocyte retrieval. The cul-de-sac is assessed for the presence of free fluid or masses.

Junctional zone thickness in young nulliparous women according to menstrual cycle and hormonal contraception use

This prospective study aims to determine the optimal menstrual phase and uterine location to detect the thickest junctional zone by magnetic resonance imaging (MRI). Healthy nulliparous women were subdivided according to their use of hormonal contraception. Each women was investigated three times during their menstrual cycle. Eighteen nulliparous non-users and 29 nulliparous users of hormonal contraception (mean age 26.4 and 25.8 years, respectively) underwent a pelvic MRI (1.5T) examination during the follicular, ovulatory and luteal phase. The junctional zone thickness was measured at six locations in the uterine wall. A significantly thinner junctional zone was observed at the anterior and posterior wall of the midcorpus (P = 0.01 and P = 0.004 respectively) and fundus (P = 0.009 and P = 0.023 respectively), in the contraception users compared with the non-users. No differences in junctional zone thickness were noticed between the menstrual phases and the uterine wall locations. The ratio of junctional zone versus total myometrial thickness was also different between both groups and between the assessed uterine locations. To conclude, any phase in the menstrual cycle and location within the uterine wall was validated to determine the junctional zone thickness on MRI, although the fundal location is preferred.

The Role of Adenomyosis in the Pathogenesis of Preeclampsia.

Adenomyosis can cause defective deep placentation. Preeclampsia is known to be associated with abnormal placentation. The aim of this study was to compare the presence of adenomyosis on magnetic resonance imaging in patients with and without history of preeclampsia in order to investigate the possible role of adenomyosis in the pathogenesis of preeclampsia. This prospective, randomized study consisted of patients with (n = 35) and without (n = 34) history of preeclampsia. Direct (submucosal microcysts, adenomyoma and cystic adenomyoma) and indirect (maximal thickness of junctional zone, ratio of maximal thickness of junctional zone to myometrial thickness, junctional zone differential, focal thickening of junctional zone, globally enlarged uterus and non-uniform junctional zone contours) signs of adenomyosis were assessed by pelvic magnetic resonance imaging. The prevalence of adenomyosis was found to be more common in patients with preeclampsia und fetal growth restriction compared to patients without fetal growth restriction (94.4 vs. 64.7 %; p = 0.041), respectively. There was a strong association between maximal thickness of junctional zone (9 vs. 13 mm, p = 0.005), ratio of maximal thickness of junctional zone to myometrial thickness (0.42 vs. 0.66, p = 0.001) and junctional zone differential (3 vs. 5 mm, p = 0.02) and late-onset preeclampsia. Presence of adenomyoma is more common in patients with preeclampsia complicated with fetal growth restriction. Indirect signs of adenomyosis detected on pelvic magnetic resonance imaging might have a role in the pathogenesis of late-onset preeclampsia.

Uterine junctional zone thickness in infertile women evaluated by MRI.

To prospectively evaluate and compare the junctional zone (JZ) and outer myometrial thickness in infertile and healthy nulliparous women at different locations in the uterine wall during the menstrual cycle by magnetic resonance imaging (MRI). We performed pelvic 1.5T MRI (T2 -weighted turbo spin echo sequences) on 28 infertile women: 5 with infertility of unknown origin, 12 anovulating, and 11 on ovarian stimulation therapy (mean age 28.5, 30.8, and 29.3 years, respectively); and a control group consisting of 18 healthy nulliparous volunteers (mean age 26.4 years). The women with unknown infertility origin and the control group underwent MRI investigations during their follicular, ovulatory, and luteal phase. The JZ and outer myometrial thicknesses were measured at six locations in the uterine wall: anterior and posterior wall of the isthmus, midcorpus, and fundus. The JZ in the anovulating women at the posterior wall of the isthmus (4.2 mm) was significantly thicker compared to the control group (3.2, 3.0, and 2.9 mm, in respectively the three menstrual phases) (P = 0.027). The outer myometrium in the anovulating women was significantly thicker at all measured locations (average 11.5 mm) in comparison to the control group (8.1, 8.0, and 8.5 mm, in respectively the three menstrual phases) (P < 0.050). The infertile women on ovarian stimulation therapy showed a significantly thicker outer myometrium at the anterior wall (isthmus, midcorpus, and fundus) (P < 0.050). The results indicate that a thickened JZ, and especially a thickened outer myometrium, might be associated with infertility. 1 J. Magn. Reson. Imaging 2017;45:926-936.