294 In this thesis, we attempted to offer a wide view of the impact of adenomyosis on the uterine contractile and reproductive function. Starting with an exploration into its non-invasive diagnosis by way of MRI, we then continued to explore its possible effect on uterine contractility function, and end with its influence on fertility and obstetric outcomes. SUMMARY OF THE RESULTS OF THIS THESIS In Chapters 2 and 3, the diagnosis of adenomyosis using multiparametric MRI was explored. First, the existing literature of objective parameters used to diagnose MRI were summarised and assessed for their accuracy in diagnosing adenomyosis versus the golden standard of histopathology. A wide variety of classification systems and parameters have been used in the diagnosis of adenomyosis, with an overarching lack of uniformity. Overall, the most commonly used parameters involved the junctional zone (JZ), with cut-off values for its maximum diameter varying, but with 12 mm being most often used. When looking at the diagnostic accuracy of each parameter in a metaanalysis, the parameters that performed best were a JZ over 12 mm (sensitivity 71.6%, specificity 85.5%) and the presence of myometrial cysts or high signal intensity foci (sensitivity 59.6% and specificity 96.1%). No one single parameter performed well across the board. Subsequently, in Chapter 3 we developed a multivariate prediction model for adenomyosis diagnosis by MRI, based on the MRI parameters as described in Chapter 2 and using retrospective MRI and pathology data from a single centre. The final model performed well (AUC of 0.78), using a combination of five clinical and four MRI parameters. An external validation study using the same developed predictive model was conducted in Chapter 4, confirming good to excellent performance of the model in a different dataset (AUC 0.83). We concluded that it is most advisable to consider both patient and imaging characteristics for an accurate diagnosis of adenomyosis on MRI. After investigating the non-invasive diagnosis of adenomyosis, we looked further into how, and if, adenomyosis indeed affects the uterine function in terms of uterine contractility. Chapter 5 introduces a method to measure uterine peristalsis on 2D transvaginal ultrasound using speckle-tracking, showing its potential for clinical applicability in IVF patients. In Chapter 6, we attempted to define ‘normal’ uterine contractile function using a novel quantitative 2D speckle tracking method on TVUS in women with healthy, sonographically normal uteri. Here, we found that uterine contraction features
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