61 Three studies (49,126,163) attempted to quantify the extent of adenomyosis by reporting the absolute number of HSI foci (on T2 imaging) in the myometrium (as shown in Figure 2.15). No cut-off value regarding the number of HSI foci has been described, with the majority of studies denoting their presence as stand-alone evidence of adenomyosis. Figure 2.15: Sagittal T2W MRI showing subtle high signal intensity (HSI) foci in the junctional zone (JZ) Four studies (52,140,141,163) described a method to quantify the SI of adenomyotic tissue further, on T2 imaging. In these studies the relative SI ratio of adenomyotic tissue was compared to that of apparently normal myometrium, or rectus muscle, and given an absolute value (see Figure 2.16 for a visualization). This ratio has not been investigated for diagnostic accuracy.
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