57 Figure 2.8: Sagittal T2W MRI showing junctional zone (JZ) and myometrial (M) thickness. The JZ to Myometrium Ratio here is 0.8 (80%) Figure 2.9: Diagnostic Performance of Junctional Zone to Myometrium Ratio > 40% on MRI vs. Histopathology Adenomyosis Lesion Size: Specifically for focal type adenomyosis, the lesion size or volume was often reported as a method to quantify the extent of adenomyosis (see Figure 2.10 for an example, n= 27 studies, see Table 2.1). The adenomyosis lesion was usually identified based on an ‘ill-defined’ low intensity area in the myometrium on T2-weighted imaging. No studies investigated this parameter in the context of diagnostic accuracy, with most studies assessing (reduction in) lesion size as a measure of treatment response. Only one study investigated lesion size with clinical outcome, and suggested that extent of lesion volume reduction after treatment may have a direct relationship with symptom reduction (52). In addition to elements of the JZ, another widely reported measure of adenomyosis on MRI is how it affects the uterus as a whole.
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