Ressonância magnética no diagnóstico da adenomiose: uma revisão narrativa

Abstract

Adenomyosis is a gynecological condition characterized by the ectopic presence of endometrial tissue within the uterine myometrium, and it can present in either focal or diffuse forms. This narrative review aims to evaluate the role of magnetic resonance imaging (MRI) in the diagnosis and clinical management of adenomyosis. Studies published between 2005 and 2025 were analyzed from databases including PubMed, Scopus, Google Scholar, and Lilacs, focusing on the application of MRI in identifying adenomyosis. MRI stands out as a non-invasive imaging modality with high sensitivity and specificity, surpassing transvaginal ultrasound (TVUS), particularly in inconclusive cases. The main diagnostic feature is a thickened junctional zone (>12 mm), although additional findings—such as small cysts, low-signal-intensity striations on T2-weighted images, and hemorrhagic foci on T1—are also relevant. MRI allows for differentiation between disease subtypes, including focal adenomyosis, diffuse adenomyosis, adenomyoma, and cystic adenomyosis, and provides comprehensive evaluation of adjacent pelvic structures. It also assists in ruling out differential diagnoses, such as leiomyomas and endometrial tumors. Despite its higher cost, MRI is recommended as a second-line imaging modality according to the 2017 guidelines of the European Society of Urogenital Radiology (ESUR), especially in the assessment of endometriosis and complex pelvic pathologies. In conclusion, MRI is an essential tool for accurate diagnosis and therapeutic planning in adenomyosis.