they may have similar presentations but possibly different treatment modalities , ie , hysterectomy for adenomyosis versus conservative management or hysterectomy for leiomyomas , or both .
however , only limited studies have been performed on the efficacy of conservative treatment of adenomyosis , and these typically do not improve or preserve fertility .
. mri provides better tissue contrast and may be superior to other imaging modalities in certain pelvic pathologies , such as congenital uterine anomalies , leiomyoma , adenomyosis , and endometriomas .
some reports suggest mri is a reliable preoperative tool available to physicians to assist in differentiating between fibroids and adenomyoma / adenomyosis . in this study
, we evaluated the predictive value of the pre - operative mri in differentiating between leiomyoma and adenomyosis compared with pathologic findings .
a 5-year retrospective chart review was performed from january 1999 to december 2004 in a university - based hospital among patients who were admitted to undergo hysterectomy , myomectomy , or both .
although 1517 charts were reviewed , only 153 patients who underwent a preoperative mri were selected for this study .
patients ranged in age from 21 to 69 with a mean age of 41 and a median age of 39 .
the presenting symptoms were as follows : 73(48% ) had menorrhagia , 34(22% ) had dysmenorrhea , 31(20% ) had pelvic pain , 40(26% ) had a pelvic mass , 16(10% ) had irregular bleeding , 14(9% ) had infertility , and 2(1.3% ) had postmenopausal bleeding .
of these patients , 50 had a hysterectomy and the other 103 had a myomectomy .
mri studies were performed in axial , sagittal , and coronal planes with various t1-weighted spin - echo and t2-weighted turbo spin - echo or spin - echo on a 1.5 tesla system ( gyro scan , phillips medical systems , bothell , washington , usa or ge open magnet mri scanners , general electric company , fairfield , connecticut , usa ) in different centers .
contrast enhanced gadolinium was used as an additive technique in 50 cases to achieve better tissue contrast in the patients suspicious for leiomyoma .
leiomyoma appeared as low - signal intensity in t2-weighted images and intermediate- to high - signal intensity in t1-weighted images .
adenomyosis was described as a focal or diffuse widening of junctional zone above 12 mm , uterine enlargement , or both , with focal or diffuse low - signal intensity myometrial area in t2-weighted images . also on contrast enhanced t1-weighted images , ( gadolinium scan ) small hypointense myometrial spots
mri interpretation was performed by different observers in different centers including private radiology centers , community and university hospitals .
mri studies were performed in axial , sagittal , and coronal planes with various t1-weighted spin - echo and t2-weighted turbo spin - echo or spin - echo on a 1.5 tesla system ( gyro scan , phillips medical systems , bothell , washington , usa or ge open magnet mri scanners , general electric company , fairfield , connecticut , usa ) in different centers .
contrast enhanced gadolinium was used as an additive technique in 50 cases to achieve better tissue contrast in the patients suspicious for leiomyoma .
leiomyoma appeared as low - signal intensity in t2-weighted images and intermediate- to high - signal intensity in t1-weighted images .
adenomyosis was described as a focal or diffuse widening of junctional zone above 12 mm , uterine enlargement , or both , with focal or diffuse low - signal intensity myometrial area in t2-weighted images .
also on contrast enhanced t1-weighted images , ( gadolinium scan ) small hypointense myometrial spots were indicative of adenomyosis .
mri interpretation was performed by different observers in different centers including private radiology centers , community and university hospitals .
the results were used to confirm the mri findings for the presence of leiomyoma and adenomyosis . according to the pathology reports , 120 had only leiomyoma , 23 had leiomyoma with coexisting adenomyosis , and 9 had adenomyosis .
one patient in the hysterectomy group had a normal mri and pathology report that revealed no myoma or adenomyosis .
fifteen patients had other pelvic pathologies coexisting with leiomyoma or adenomyosis , or coexisting with both .
mri studies correctly diagnosed 136 of 144 patients with leiomyoma . in the remaining 8 patients with leiomyoma
data analyses were as follows : sensitivity 94% , specificity 33% , positive predictive value 95% , and negative predictive value 27% .
for adenomyosis , in 31 patients , mri revealed true positive , false - positive , and false - negative results in 12 , 11 , and 19 patients , respectively .
the positive and negative predictive values of mri for adenomyosis were 52% , 85% , respectively , with 38% sensitivity and 91% specificity . as mentioned previously
mri revealed correct diagnoses in only 9/23 patients , in 12/23 it revealed only myoma , and in 2/23 it diagnosed only adenomyosis .
adenomyosis and leiomyoma are 2 benign uterine conditions with similar clinical presentations and different pathogeneses .
adenomyosis or internal endometriosis is a disease of parous women with the peak incidence between 40 to 50 years of age .
it is characterized by the presence of endometrial glands and stroma inside the uterine myometrium . according to different histological interpretations of the hysterectomy specimens , frequency of adenomyosis
uterine involvement may be focal or diffuse , and the size of the lesion ranges from a gross macroscopic well - defined lesion ( adenomyoma that mimics myoma ) to a microscopic lesion .
uterine leiomyoma is a benign smooth muscle tumor with 25% prevalence in women of reproductive age with a predominance among african american women .
furthermore , pathology examination of surgical specimens revealed an incidence of leiomyoma as high as 77% .
a definitive diagnosis for both categories is possible based on histological examination of surgical specimens , but imaging techniques are increasingly used for preoperative evaluation and diagnosis .
transvaginal ultrasound and pelvic mri are increasingly used as a preoperative diagnostic tool for adenomyosis . although both techniques have been reported to have almost the same sensitivity ( 68% versus 70% ) , the specificity is greater for mri ( 86% versus 65% ) .
pelvic mri is also used in the diagnosis of leiomyoma when a patient 's obesity or extreme uterine retroversion , or both , hinder pelvic ultrasound performance .
pelvic mri is highly specific in the diagnosis of adenomyosis ( 91% ) and highly sensitive for leiomyoma ( 94% ) according to our findings .
currently , pelvic ultrasound , a relatively affordable and effective method , is widely used as an office procedure in the diagnosis of leiomyoma .
it is more efficacious to limit the use of mri for specific conditions when uterine preservation is the goal of therapy , such as localization of leiomyoma in an infertile patient or when the patient is a candidate for uterine artery embolization .
our results are different from the results in previously published reports that indicated a higher sensitivity ( 70% vs. 38% ) of mri for adenomyosis and higher specificity ( 100% vs. 33% ) for leiomyoma .
this can possibly be explained because our study was influenced by selection bias . because the study was performed on a diseased population with a previous diagnosis of myoma or adenomyosis , or both , where ultrasound alone was thought by the physician to be inadequate .
therefore , there were very few patients in our study with negative findings , leading to a low specificity . however , it was not possible to select another population , because of the retrospective nature of the study .
also , mri studies were done in different centers and interpreted by different radiologists , which may produce interobserver bias .
like other radiological studies , mri is highly operator dependent , and the results may be influenced by technical and observer interpretation .
however , this may be a strength of the study in the sense that in reality there will not always be the same specialist reviewing all the studies . of 153 patients who had mri as a preoperative diagnostic tool , 103 underwent myomectomies , so there may be an inherent bias against identifying false - negative adenomyosis .
at the present time , pelvic ultrasound is used as a first line for the diagnosis of uterine pathology .
however , it may be helpful for diagnosis of pelvic pathologies that are not well defined with ultrasound studies .
we suggest mri be used as a complementary diagnostic tool in patients whose ultrasound examination does not clarify the diagnosis , such as in extreme uterine retroversion or obesity , or both , and in patients whose ultrasound examination is indicative of adenomyosis and there is a desire for conservative management .
if the preoperative mri shows no adenomyosis , patients can be counseled of the low likelihood of having adenomyosis ( 15% ) and therefore conservative management can be offered .
 objective : we evaluated the role of mri as a preoperative diagnostic tool for leiomyoma and adenomyosis.method:this is a retrospective chart review at a university - based hospital . 
 the study included 1517 women who underwent hysterectomy or myomectomy over a 5-year period , and 153 women with a preoperative pelvic mri were included . 
 comparisons were made between the results of the mri and postoperative pathology reports.results:the mri and pathology report were the same for 136 of 144 women with leiomyoma and 12 of 31 women with adenomyosis . 
 the mri had 94% sensitivity and 33% specificity for leiomyoma and 38% sensitivity and 91% specificity for adenomyosis . 
 positive and negative predictive values of mri for leiomyoma were 95% and 27% with 90% accuracy . 
 positive and negative predictive values of mri for adenomyosis were 52% and 85% , respectively , with 80% accuracy.conclusion:mri has a high sensitivity and a low specificity for diagnosing leiomyoma and a high specificity and a low sensitivity for diagnosing adenomyosis . due to the high cost and technical variations 
 , we suggest using mri only as an adjunctive diagnostic tool when ultrasound is not conclusive and differentiation between the 2 pathologies ultimately affects patient management . 
INTRODUCTION
METHODS
MRI Studies
RESULTS
DISCUSSION
CONCLUSION