54 Adenomyosis Signal intensity ratio on T2 imaging Signal intensity ratio of adenomyotic tissue compared to rectus muscle or normal myometrium (measured in ROI of the same size) N=4 (52,140,141,163) ADC Value Apparent Diffusion Coefficient of adenomyotic tissue on DWI N=5 (119,139,140,143,172) *Reference numbers refer to the full reference list of the included studies as reported in the supplementary file Junctional Zone Thickness JZ thickness was the most widely reported objective measure of adenomyosis. Fifty-six studies (see Table 2.1 for details) reported the measurement of the thickness of the JZ in the assessment, or diagnosis, of adenomyosis. Studies reported differing threshold values of the JZ, with the cut-off ranging between 5 mm (113) and 15 mm (122), with 12mm being the most common (see Figure 2.4 for an example). The individual diagnostic accuracy of this value was reported in four studies, see Table 2.2, Figure 2.5 and Figures 2.S1 and 2.S2 for details. Most studies reported using the mean JZ diameter to assess adenomyosis, but several studies also separately noted the maximum (JZ Max, n= 1 and minimum (JZ Min, n=5) diameter. Figure 2.4: Sagittal T2W MRI showing the junctional zone (JZ) with a diameter of >12m
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