2 99 same can be said for radiologists when assessing MRIs for adenomyosis (295). The problem of underreporting in MRI diagnosis was baldly present in the results seen in Chapters 2 and 3, where accuracy of initial radiologist reported diagnosis of adenomyosis was much lower at approximately 60% rather than 78-80% touted in the literature. These facts should serve as the impetus for further standardisation of diagnostic criteria across the board in adenomyosis, and highlight the road that still needs to be travelled for accurate multi-modal diagnosis. - Objective Two: Measuring uterine contractility, and how adenomyosis affects it – proof of JZ involvement? The potential physiological function of the JZ in both healthy and adenomyotic uteri was investigated in Chapters 5, 6 and 8 by way of the objective assessment of uterine contractility. The novel 2D TVUS speckle tracking method employed in these studies both provides novel insights into the intricacies of the uterine function, and proves that it tends to follow a standard pattern of behaviour throughout the natural menstrual cycle. Our method assesses uterine movement specifically in the junctional zone area between the endometrium and myometrium. Chapter 8 goes further and supports that uterine abnormalities like adenomyosis may affect its integrity. Previous studies have suggested potential mechanisms as to how adenomyosis may affect uterine contractility in the JZ, but these aberrant contractions have not been visualised as such until our study (8,294). Uterine movement in adenomyosis is potentially disrupted due to a possible combination of anatomical, inflammatory and physiological changes in the junctional zone. It is as of yet unclear if these changes are a cause or an effect of the adenomyosis present, but they undoubtedly have an effect on the structure and function of the uterus as a whole. Anatomical changes of the JZ occur due to the proliferation of smooth muscle cells around adenomyosis implants (as seen on histology). Where present, these muscle fibre bundles, due to their disorganised structure, are not able to contract in as coordinated a fashion as in normal myometrium (297). It stands to reason that the more of the JZ and myometrial tissue that is affected (by adenomyosis), the more uncoordinated and aberrant uterine contractions then become, leading to dysperistalsis. Once the integral structure of the JZ is affected, a vicious cycle ensues, leading to disruption of the basilar membrane between the
RkJQdWJsaXNoZXIy MTk4NDMw