63 Table 2.2: Pooled Diagnostic Accuracy of Individual MRI Parameters for Adenomyosis Adenomyosis MRI Feature Studies investigating diagnostic accuracy (n) Pooled Sensitivity (%, 95% CI) Pooled Specificity (%, 95% CI) JZ Thickness > 12mm 4 71.6 (46.0 – 88.2) 85.5 (52.3 – 97) JZ Differential >5mm 2 58.2 (44.3-72.1) 83.2 (71.3 – 90.8) JZ to Myometrium Ratio >40% 2 63.3 (51.9-73.4) 79.4 (42.0-95.4) Enlarged Uterus 2 42.9 (15.9-74.9) 87.7 (37.9 – 98.8) Myometrial Cysts 3 59.6 (41.6-75.4) 96.1 (80.7 – 99.3) Correlation with Clinical outcomes: JZ thickness was most often investigated as an in relation to clinical outcomes. Several studies (n= 8) used (reduction in) JZ thickness as a measure of therapy response, but relatively few studies investigated (change in) JZ thickness and other clinical outcomes. Those that did, reported conflicting results (51,59,72,152). Froeling et al. and Fukunishi et al. could not find a direct relationship between JZ thickness and symptom reduction or severity (53,136). Conversely, four other studies did report an direct association between duration and severity of dysmenorrhea and JZ thickness (59,60,77,152). An increase of average JZ thickness with age, suggesting a relationship to higher incidence of adenomyosis in older women has also been reported (72,77,100). Kunz et al. (100) and Kissler et al. (51) investigated JZ thickness in the context of uterine dysperistalsis-associated infertility but did not find a significant relationship. Further studies (8,12,149,151) evaluated JZ thickness in the context of endometriosis phenotypes, whereby Larsen et al. (149) reported an increased mean JZ in conjunction with endometriosis severity. Chapron et al. refuted this however (12). Uterine size and morphology has also been somewhat correlated to clinical outcomes (see Table 1), with uterine volume sometimes used in the context of symptom reduction. Generally, uterine size was directly associated with severity of adenomyosis symptoms. Furthermore, several attempted to correlate tissue signal intensity with therapy response (49,144,163). Keserci et al. (52) suggested that a lower
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