MAGNETIC-RESONANCE-IMAGING OF THE UTERUS AFTER ENDOMETRIAL RESECTION

Objective Despite the increasing popularity of endometrial resection f or the treatment of menstrual problems, the long term sequelae of this procedure are poorly recognised. As diagnostic hysteroscopy following endometrial resection is frequently unrewarding and transvaginal ultr asound is incapable of detecting subtle changes in endometrial morphol ogy, magnetic resonance imaging was employed to evaluate the uterus. D esign Retrospective study of unselected post-operative women. Methods Fifty-nine women, of whom 22 were amenorrhoeic, were studied a mean nu mber of 34 months after endometrial resection, using a 1.5 Tesla magne tic resonance imaging system with a pelvic phased array coil for signa l reception. T2-weighted FSE images were acquired through the long and short uterine axis and volumetric assessment of each uterine layer pe rformed using an ISG Allegro workstation. Main outcome measures The lo cation and volume of residual endometrium, the volume of junctional zo ne and myometrial tissue, and the presence of additional intrauterine and pelvic pathology were recorded. Results Residual endometrium was d emonstrated in all except three amenorrhoeic women, with a similar mea n volume present in menstruating and amenorrhoeic groups. Additional f indings included adenomyosis, haematometra, fallopian tube dilatation and free intraperitoneal fluid. Conclusions The majority of amenorrhoe ic and all menstruating women have residual endometrium after endometr ial resection. The lack of communication of islands of residual endome trium with the uterine cavity results in haematometra formation, fallo pian tube dilatation and possibly free intraperitoneal fluid.