62 Figure 2.16: Sagittal T2W MRI showing an example of adenomyosis tissue (A) signal intensity (SI) versus that of the rectus muscle (R) Tissue Diffusion Characteristics Finally, five studies (see Table 2.1) used diffusion weighted imaging (DWI) to characterize adenomyosis, and attempted to quantify this. In these studies, the apparent diffusion coefficient (ADC) was measured for adenomyotic tissue compared to healthy uterus tissue, or other types of lesions (fibroids, sarcomas). DWI allows visualization of water diffusion characteristics of different types of tissue, of which ADC is a quantitative measure (173). Tian et al. (119) investigated the added value of adenomyosis DWI and ADC values, and found it significantly improved diagnostic accuracy compared to conventional MRI sequences (95.7% vs. 89.1% respectively). Similarly, Kilickesmez et al. (143) found that JZ tissue in adenomyosis patients had significantly different ADC values compared to JZ tissue in healthy patients (albeit not compared to histopathological diagnosis).
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