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

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Abstract

Objectives

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.

Methods

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.

Results

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)).

Conclusions

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.

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Abbreviations

AUC:

Area under the receiver operating characteristics curve

ICC:

Intraclass correlation coefficient

JZ:

Junctional zone

MRI:

Magnetic resonance imaging

NPV:

Negative predictive value

PPV:

Positive predictive value

R1:

Reader 1

R2:

Reader 2

ROC:

Receiver operating characteristics

T1W:

T1-weighted

T2W:

T2-weighted

TSE:

Turbo spin echo

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Acknowledgments

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

Funding

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.

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Authors and Affiliations

  1. Department of Gynecology, Oslo University Hospital, PB 4950, Nydalen, N-0424, Oslo, Norway

    Tina Tellum, Gordana V. Matic, Johann B. Dormagen, Ellen Viktil, Erik Qvigstad & Marit Lieng

  2. Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway

    Tina Tellum, Erik Qvigstad & Marit Lieng

  3. Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway

    Tina Tellum, Gordana V. Matic, Johann B. Dormagen, Ellen Viktil, Erik Qvigstad & Marit Lieng

  4. Department of Informatics, The Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway

    Staale Nygaard

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  1. Tina Tellum
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  2. Gordana V. Matic
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  3. Johann B. Dormagen
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Corresponding author

Correspondence to Tina Tellum.

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Guarantor

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.

Methodology

• Prospective

• Diagnostic or prognostic study

• Performed at one institution

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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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Tellum, T., Matic, G.V., Dormagen, J.B. et al. Diagnosing adenomyosis with MRI: a prospective study revisiting the junctional zone thickness cutoff of 12 mm as a diagnostic marker. Eur Radiol 29, 6971–6981 (2019). https://doi.org/10.1007/s00330-019-06308-3

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  • DOI: https://doi.org/10.1007/s00330-019-06308-3

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