46 METHODS: The full review protocol can be found on the PROSPERO database, with protocol ID CRD42020163106. Data Sources: The search was conducted in online databases PubMed (MEDLINE), Embase and Cochrane, and relevant articles were also screened for additional references missed in the initial search. The search was conducted using synonyms and keywords relating to adenomyosis and MRI. Full search details can be found in the supplementary file. Main outcome measures: The outcomes of this review were the existing objective measures of adenomyosis on MRI, and their (if stated) individual diagnostic accuracy and relationship to clinical outcomes. Study eligibility We included studies investigating the diagnosis, evaluation or classification of adenomyosis objectively based on MRI. Studies were included regardless of study design, use of hormonal therapy, age, or clinical manifestation. Studies written in English, Dutch or French were considered for inclusion, published up to April 7th 2020. Data reported in secondary analysis (reviews), case reports, letters to editors, conference abstracts, and protocols for ongoing studies were excluded. We also excluded studies that only reported subjective measures of adenomyosis on MRI, for instance: lesion localisation, subjective signal intensity i.e. ‘dark’ or ‘low’, or only noting ‘JZ irregularity’ without objectifying this (by measurement in mm). Quality assessment and risk of bias: A risk of bias assessment of included studies was only carried out for the studies investigating diagnostic accuracy, using the QUADAS-II tool (22, Tables 2.S8-2.S11). Risk of bias summary graphs and tables were constructed
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