12 SUMMARY: Adenomyosis is a common and potentially debilitating benign gynaecological condition characterised by the infiltration of endometrial tissue and stroma into the uterine myometrium. Associated symptoms are dysmenorrhoea, heavy menstrual bleeding, and subfertility, which can greatly impact quality of life. Adenomyosis often occurs in conjunction with endometriosis and is considered part of the spectrum of the same disease. The reported prevalence of adenomyosis is still uncertain, with estimates ranging from as low as 5% up to 85%. The lack of uniform diagnostic criteria for adenomyosis, and the fact that up to a third of women are asymptomatic (or do not present themselves to a clinician), exacerbates this problem. Historically, adenomyosis was only diagnosed on histopathology after hysterectomy at the end of a woman’s fertile phase of life. However, modern advances in non-invasive imaging have shown that adenomyosis is present in younger nulliparous women. With this knowledge, adenomyosis is being linked not only to clinical symptoms, but also to infertility and obstetric complications. Non-invasive and accurate diagnosis, along with clarity into the impact adenomyosis has on fertility and pregnancy, is thus crucial. Hence, we assessed the effect of adenomyosis on uterine contractile and reproductive function, starting with an exploration into its non-invasive diagnosis by way of MRI, and ending with its influence on fertility and obstetric outcomes. First, we conducted a literature study on the existing MRI-based diagnostic criteria for adenomyosis and carried out a meta-analysis into their reported diagnostic accuracy. We surmised that whilst a wide variety of MRI-based parameters have been used and reported, no uniformly applied criteria exist. Moreover, the individual diagnostic accuracy of each parameter is unclear. Based on the criteria described in the literature, we developed a multivariate diagnostic predictive tool for adenomyosis diagnosis using a retrospective cohort of patients with histologically confirmed adenomyosis. We also were able to validate this method using an external patient cohort. One promising element of MRI-based diagnosis parameter is the uterine anatomical ‘junctional zone’, which coordinates rhythmic uterine contractions,
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