Benign Diseases of the Uterus

  • Susan Ascher
  • Caroline Reinhold


Endovaginal ultrasonography (EVUS) remains the procedure of choice for initial evaluation of benign diseases of the female genital tract. When EVUS findings are indeterminate, further evaluation is typically performed with magnetic resonance imaging (MRI) due to its excellent soft tissue differentiation, multiplanar capabilities, and absence of ionizing radiation. MRI is thus well suited for imaging women of reproductive age. It is used as a problem-solving tool in benign uterine disease — for example, uterine malformations, and adenomyosis, and to select appropriate candidates for therapies such as myomectomy and uterine artery embolization. It is also increasingly used in the pregnant patient for both fetal and maternal indications. The role of computed tomography (CT) is limited in the evaluation of benign disease of the female pelvis and is usually employed in an emergency situation, such as in an acute abdomen caused by ovarian torsion or pelvic inflammatory disease.


Uterine Artery Embolization Endometrial Polyp Endometrial Cavity Rudimentary Horn Endometrial Pathology 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Smith-Bindman R, Kerlikowske K, Feldstein VA et al (1998) Endovaginal ultrasound to exclude endometrial cancer and other endometrial abnormalities. JAMA 280:1510–7.PubMedCrossRefGoogle Scholar
  2. 2.
    Troiano RN, McCarthy SM (2004) Müllerian duct anomalies: imaging and clinical issues. Radiology 233:19–34.PubMedCrossRefGoogle Scholar
  3. 3.
    Behr SC, Coutier JL, Qayyum A (2012) Imaging of Müllerian duct anomalies. RadioGraphics 32:1619–1620.CrossRefGoogle Scholar
  4. 4.
    Li S, Qayyum A, Coakley FV, Hricak H (2000) Association of renal agenesis and müllerian duct anomalies. J Comput Assist Tomogr 24:829–834.PubMedCrossRefGoogle Scholar
  5. 5.
    Buttram VC Jr, Gibbons WE (1979) Müllerian anomalies: a proposed classification. (An analysis of 144 cases.) Fertil Steril 32:40–46.PubMedGoogle Scholar
  6. 6.
    The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, müllerian anomalies and intrauterine adhesions (1988). Fertil Steril 49:944–955.Google Scholar
  7. 7.
    Mueller GC, Hussain HK, Smith YR et al (2007) Müllerian duct anomalies: comparison of MRI diagnosis and clinical diagnosis. AJR Am J Roentgenol 189:1294–1302.PubMedCrossRefGoogle Scholar
  8. 8.
    Jayasinghe Y, Rane A, Stalewski H, Grover S (2005) The presentation and early diagnosis of the rudimentary uterine horn. Obstet Gynecol 105:1456–1467.PubMedCrossRefGoogle Scholar
  9. 9.
    Pellerito JS, McCarthy SM, Doyle MB et al (1992) Diagnosis of uterine anomalies: relative accuracy of MR imaging, endovaginal sonography, and hysterosalpingography. Radiology 183:795–800.PubMedCrossRefGoogle Scholar
  10. 10.
    Fedele L, Dorta M, Brioschi D et al (1989) Magnetic resonance evaluation of double uteri. Obstet Gynecol 74:844–847.PubMedGoogle Scholar
  11. 11.
    Miller RJ, Breech LL (2008) Surgical correction of vaginal anomalies. Clin Obstet Gynecol 51:223–236.PubMedCrossRefGoogle Scholar
  12. 12.
    Rackow BW, Arici A (2007) Reproductive performance of women with müllerian anomalies. Curr Opin Obstet Gynecol 19:229–237.PubMedCrossRefGoogle Scholar
  13. 13.
    Propst AM, Hill JA 3rd (2000) Anatomic factors associated with recurrent pregnancy loss. Semin Reprod Med 18:341–350.PubMedCrossRefGoogle Scholar
  14. 14.
    Zreik TG, Troiano RN, Ghoussoub RA et al (1998) Myometrial tissue in uterine septa. J Am Assoc Gynecol Laparosc 5:155–160.PubMedCrossRefGoogle Scholar
  15. 15.
    Chandler TM, Machan LS, Cooperberg PL et al (2009) Müllerian duct anomalies: from diagnosis to intervention. Br J Radiol 82:1034–1042.PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Tulandi T, Arronet GH, McInnes RA (1980) Arcuate and bicornuate uterine anomalies and infertility. Fertil Steril 34:362–364.PubMedGoogle Scholar
  17. 17.
    Kaufman RH, Adam E, Binder GL, Gerthoffer E (1980) Upper genital tract changes and pregnancy outcome in offspring exposed in utero to diethylstilbestrol. Am J Obstet Gynecol 137:299–308.PubMedGoogle Scholar
  18. 18.
    Goldberg JM, Falcone T (1999) Effect of diethylstilbestrol on reproductive function. Fertil Steril 72:1–7.PubMedCrossRefGoogle Scholar
  19. 19.
    Sheth S, Hamper UM, Kurman RJ (1993) Thickened endometrium in the postmenopausal woman; sonographic-pathologic coorelation. Radiology 187:135–139.PubMedCrossRefGoogle Scholar
  20. 20.
    Grasel RP, Outwater EK, Siegelman ES et al (2000) Endometrial polyps: MR imaging features and distinction from endometrial carcinoma. Radiology 214:47–52.PubMedCrossRefGoogle Scholar
  21. 21.
    Hricak H, Tscholakoff D, Heinrichs L et al (1986) Uterine leiomyomas: correlation of MR histopathologic findings, and symptoms. Radiology 158:385–391.PubMedCrossRefGoogle Scholar
  22. 22.
    Cardozo ER, Clark D, Banks NK et al (2012) The estimated annual cost of uterine leiomyomata in the United States. Am J Obstet Gynecol 206:21.e1–9.Google Scholar
  23. 23.
    Jacobson GF, Shaber RE, Armstrong MA, Hung Y-Y (2007) Changes in rates of hysterectomy and uterine conserving procedures for treatment of uterine leiomyoma. Am J Obstet Gynecol 196:601.e1–6.Google Scholar
  24. 24.
    Jha RC, Ascher SM, Imaoka I, Spies JB (2000) Symptomatic fibroleiomyomata: MR imaging of the uterus before and after uterine artery embolization. Radiology 217:228–35.PubMedCrossRefGoogle Scholar
  25. 25.
    Nikolaidis PN, Siddiqi AH, Carr JC et al (2005) Incidence of nonviable leiomyomas on contrast material enhanced pelvic MR imaging in patients referred for uterine artery embolization. J Vasc Interv Radiol 16:1465–1471.PubMedCrossRefGoogle Scholar
  26. 26.
    Kroencke TJ, Scheurig C, Poellinger A et al (2010) Uterine artery embolization for leiomyomas: percentage of infarction predicts clinical outcome. Radiology 255:834–841.PubMedCrossRefGoogle Scholar
  27. 27.
    Kitamura Y, Ascher SM, Cooper C et al (2005) Imaging manifestations of complications associated with uterine artery embolization. RadioGraphics 25:S119–32.PubMedCrossRefGoogle Scholar
  28. 28.
    Radeleff B, Eiers M, Bellemann N et al (2010) Expulsion of dominant submucosal fibroids after uterine artery embolization. Eur J Radiol 75:e57–63.PubMedCrossRefGoogle Scholar
  29. 29.
    Shah SH, Jagannathan JP, Krajewski K et al (2012) Uterine sarcoma: then and now. AJR Am J Roentgenol 199:213–223.PubMedCrossRefGoogle Scholar
  30. 30.
    Thomassin-Naggara, Dechoux S, Bonneau C et al (2013) How to differentiate benign from malignant myometrial tumors using MR imaging. Eur Radiol 23:2306–2314.PubMedCrossRefGoogle Scholar
  31. 31.
    Reinhold C, McCarthy S, Bret PM et al (1996) Diffuse adenomyosis: comparison of endovaginal US and MR imaging with histopathologic correlation. Radiology 199:151–158.PubMedCrossRefGoogle Scholar
  32. 32.
    Togashi K, Ozasa H, Konishi I et al (1989) Enlarged uterus: differentiation between adenomyosis and leiomyoma with MR imaging. Radiology 171:531–534.PubMedCrossRefGoogle Scholar
  33. 33.
    Mark AS, Hricak H, Heinrichs LW et al (1987) Adenomyosis and leiomyoma: differential diagnosis with MR imaging. Radiology 163:527–529.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2014

Authors and Affiliations

  • Susan Ascher
    • 1
  • Caroline Reinhold
    • 2
  1. 1.Georgetown University School of MedicineGeorgetown University HospitalWashington, DCUSA
  2. 2.Gynecology and Internal MedicineMcGill University Health CenterMontrealCanada

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