European Radiology

, Volume 29, Issue 12, pp 6971–6981 | Cite as

Diagnosing adenomyosis with MRI: a prospective study revisiting the junctional zone thickness cutoff of 12 mm as a diagnostic marker

  • Tina TellumEmail author
  • Gordana V. Matic
  • Johann B. Dormagen
  • Staale Nygaard
  • Ellen Viktil
  • Erik Qvigstad
  • Marit Lieng



To assess the diagnostic accuracy of a junctional zone (JZ) thickness of ≥ 12 mm and morphological features of the JZ in MRI in diagnosing adenomyosis in a premenopausal study population.


This single-center, prospective observational study consecutively enrolled 93 premenopausal women suffering from a benign gynecological condition, from September 2014 to August 2016. Institutional review board approval and written consent were obtained. All participants underwent MRI and hysterectomy with a histopathological examination. MR images were evaluated in a blinded fashion by two independent readers. The maximum junctional zone thickness (JZmax), presence of JZmax ≥ 12 mm, and any irregular appearance of the JZ (defined as irregular outer or inner borders, focal thickening, presence of high-intensity signal foci, or fingerlike indentations at the inner border) were documented, and the diagnostic performance was evaluated with the AUC, chi-square test, and multiple regression.


Adenomyosis was histopathologically confirmed in 57 (61%) of the women. JZmax was not positively correlated with adenomyosis diagnosis (AUC = 0.57, p = 0.26) and did not differ significantly between those with and without adenomyosis (10.3 vs 10.1 mm, p = 0.88), nor was a cutoff of JZmax ≥ 12 mm (n = 30/57 (53%) vs n = 16/36 (44%), p = 0.29). The presence of an irregular JZ showed the best association with adenomyosis among the evaluated signs (sensitivity 74% (95% CI, 60, 85); specificity 83% (95% CI, 67, 94) (p < 0.001)).


JZmax was not correlated with adenomyosis in the present premenopausal study population, but direct signs of adenomyosis such as irregularities of the JZ provided a good diagnostic accuracy.

Key Points

• Measuring the junctional zone thickness is of limited value for diagnosing adenomyosis with MRI and should not be used for diagnosing adenomyosis in premenopausal women with moderate disease severity.

• An irregular appearance of the junctional zone, the presence of myometrial cysts, and adenomyoma appear to provide the highest specificity for diagnosing adenomyosis.

• A consensus for the definition and reading of the junctional zone is needed.


Adenomyosis Magnetic resonance imaging Hysterectomy Prospective studies Infertility 



Area under the receiver operating characteristics curve


Intraclass correlation coefficient


Junctional zone


Magnetic resonance imaging


Negative predictive value


Positive predictive value


Reader 1


Reader 2


Receiver operating characteristics






Turbo spin echo



The authors thank Else Kathrine Skovholt, M.D. for the analysis of the histopathological specimen.


The first author received a PhD-grant from the Norwegian Women’s Health Association (Norske Kvinners Sanitetsforening) to perform this study (grant number NKS14901), who was involved in neither the design, data analysis, nor publication of this study.

Compliance with ethical standards


The scientific guarantor of this publication is Prof. Marit Lieng.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Staale Nygaard kindly provided statistical advice for this manuscript. Also, several of the authors have significant statistical expertise. However, no complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects in this study.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Ultrasound examination was performed on the whole study cohort; the results are reported elsewhere [12]. The data reported in this article have no overlap with previously published work.


• Prospective

• Diagnostic or prognostic study

• Performed at one institution

Supplementary material

330_2019_6308_MOESM1_ESM.docx (18 kb)
Supplementary Table 1 Protocol for magnetic resonance imaging.aPerpendicular to the long axis of the uterine cavity. bParallel to the long axis of the uterine cavity. T1W, T1-weighted; T2W, T2-weighted; B-TFE, balanced turbo field echo; TSE, turbo spin echo; VISTA, Volumetric Isotropic TSE Acquisition (DOCX 18 kb)


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  1. 1.Department of GynecologyOslo University HospitalOsloNorway
  2. 2.Institute of Clinical Medicine, Faculty of MedicineUniversity of OsloOsloNorway
  3. 3.Department of Radiology and Nuclear MedicineOslo University HospitalOsloNorway
  4. 4.Department of Informatics, The Faculty of Mathematics and Natural SciencesUniversity of OsloOsloNorway

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