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Through thick and thin: a pictorial review of the endometrium

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Abstract

The purpose of this pictorial review is to describe the normal appearance of the endometrium and to provide radiologists with an overview of endometrial pathology utilizing case examples. The normal appearance of the endometrium varies by age, menstrual phase, and hormonal status with differing degrees of acceptable endometrial thickness. Endometrial pathology most often manifests as either focal or diffuse endometrial thickening, and patients frequently present with abnormal vaginal bleeding. Endovaginal ultrasound (US) is the first-line modality for imaging the endometrium. This article will discuss the endometrial measurements used to direct management and workup of symptomatic patients and will discuss when additional imaging may be appropriate. Three-dimensional US is complementary to two-dimensional ultrasound and can be used as a problem-solving technique. Saline-infused sonohysterogram is a useful adjunct to delineate and detect focal intracavitary abnormalities, such as polyps and submucosal fibroids. Magnetic resonance imaging is the preferred imaging modality for staging endometrial cancer because it best depicts the depth of myometrial invasion and cervical stromal involvement. Unique imaging features and complications of endometrial ablation will be introduced. At the completion of this article, the reader will understand the spectrum of normal endometrial findings and will understand the workup of common endometrial pathology.

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Acknowledgments

The authors would like to acknowledge Kelly Viola, ELS, and Allison Dowdell for assistance in manuscript preparation.

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Authors and Affiliations

  1. Department of Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA

    Melanie P. Caserta & Candice Bolan

  2. Department of Radiology, Naval Medical Center Portsmouth, 620 John Paul Jones Circle, Portsmouth, VA, 23702, USA

    M. Jennings Clingan

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  1. Melanie P. Caserta
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  2. Candice Bolan
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Correspondence to Melanie P. Caserta.

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The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the U.S. Government.

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Caserta, M.P., Bolan, C. & Clingan, M.J. Through thick and thin: a pictorial review of the endometrium. Abdom Radiol 41, 2312–2329 (2016). https://doi.org/10.1007/s00261-016-0930-5

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