Advanced Adenomyosis Successfully Treated with Radiofrequency Ablation (RFA): MRI Before-and-After Evidence
Adenomyosis is a chronic gynaecological condition in which endometrial tissue infiltrates the uterine muscle, causing progressive enlargement of the uterus, severe menstrual symptoms, pelvic pain, and a decline in quality of life. As the disease advances, treatment becomes increasingly challenging, particularly for women who wish to preserve their uterus.
This case demonstrates how Radiofrequency Ablation (RFA) was used to treat advanced adenomyosis, with treatment success clearly documented through MRI imaging.
Initial Assessment: Extensive Adenomyosis on MRI
The pre-treatment MRI revealed a large adenomyotic lesion occupying a significant portion of the uterine wall. The abnormal tissue had infiltrated deeply into the myometrium, resulting in marked uterine enlargement and distortion of the normal uterine structure.
The extent of disease visible on MRI confirmed that the adenomyosis was not confined to a small focal area but involved a substantial volume of uterine muscle. This level of involvement required precise treatment planning to maximise lesion reduction while preserving healthy uterine tissue.
Rather than removing the uterus through hysterectomy, Dr Ki-yeol Yang pursued a uterus-preserving strategy aimed directly at the diseased tissue.
Treatment Approach: Radiofrequency Ablation (RFA)
Following a detailed MRI evaluation, Radiofrequency Ablation was selected as the treatment modality.
Using image-guided technology, a specialised RFA electrode was accurately positioned within the adenomyotic lesion. Controlled radiofrequency energy was then delivered into the targeted tissue.
The thermal energy generated within the lesion produced coagulative necrosis of the adenomyotic tissue, effectively destroying the abnormal cells while minimising injury to the surrounding healthy myometrium.
This targeted approach allows treatment to be concentrated within the lesion itself rather than removing the entire uterus.
The procedure was performed to reduce adenomyotic volume, improve uterine architecture, and address the underlying source of disease.
MRI Findings After Treatment
The follow-up MRI demonstrated a significant radiological response.
Compared with the initial scan, the treated adenomyotic lesion showed substantial volume reduction. The area that had previously occupied a large portion of the uterine wall had regressed considerably following ablation.
Post-treatment imaging also revealed favourable structural changes within the uterus, indicating successful destruction of the targeted adenomyotic tissue.
Most importantly, the MRI findings provided objective confirmation that the treatment effect extended beyond symptom management and resulted in measurable anatomical improvement.
Before vs. After: What Changed?
Before RFA
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Extensive adenomyotic tissue infiltration within the uterine wall
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Enlarged uterus with disrupted uterine architecture
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Large disease burden visible on MRI
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Significant structural distortion caused by adenomyosis
After RFA
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Marked reduction in adenomyotic lesion volume
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Clear radiological evidence of tissue regression
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Improved uterine structural appearance
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Successful ablation changes confirmed on MRI
Why This Case Is Clinically Meaningful
One of the most valuable aspects of this case is that the treatment response can be directly visualised.
Many therapies for adenomyosis are evaluated primarily through symptom improvement. In contrast, this case demonstrates measurable radiological changes that can be objectively assessed on MRI.
The before-and-after imaging confirms that the adenomyotic tissue itself was successfully targeted and reduced following treatment.
For physicians, MRI evidence provides reliable confirmation of treatment efficacy. For patients, it offers visual reassurance that meaningful structural improvement has occurred within the uterus.
What This Case Shows
This case illustrates how advanced adenomyosis can be managed with a uterus-preserving approach using Radiofrequency Ablation. Through careful MRI-based planning and image-guided treatment, Dr Ki-yeol Yang achieved a substantial reduction of adenomyotic tissue, with outcomes clearly documented on follow-up imaging.
The MRI comparison serves as compelling evidence that targeted RFA can effectively reduce adenomyotic lesion volume and improve uterine structure without the need for hysterectomy, highlighting its role as a valuable minimally invasive treatment option for appropriately selected patients.