67 Another noteworthy issue is that included studies used different definitions of adenomyosis. Whilst the definition used was often similar, exact criteria and cut-off values varied. This difference persisted in recent studies, which confirms a lack of consensus regarding diagnostic criteria for adenomyosis on MRI. The histopathological definition used for adenomyosis was similarly often unclearly defined. Despite these limitations, we do believe the results of our review are clinically relevant and highlight future research opportunities. Our inability to comprehensively summarize the clinical impact of adenomyosis on MRI serves in highlighting the need for studies which specifically investigate this correlation. If the MRI phenotype of adenomyosis can be definitively linked to certain clinical outcomes (fertility, treatment response, symptom severity), this would be of great value for both clinicians and patients. The overview provided here can form the basis for such research, and thereby aid in the creation of an objective, accurate, clinically applicable, and commonly accepted classification system of adenomyosis. The development of a (patientspecific) diagnostic tool or predictive algorithm based on individual MRI parameters could also be facilitated by the results presented here. CONCLUSION: This review has identified three main characteristics that can be quantified on MRI in order to visualize the extent of adenomyosis. These characteristics are also of generally acceptable diagnostic accuracy and can be used to differentiate adenomyosis on MRI from other uterine lesions and disorders. Knowledge of these parameters can form the basis for much-needed research into how adenomyosis severity on MRI can be related to clinical outcomes and aid in the development of an objective diagnostic tool for adenomyosis. More research into the characterization of adenomyosis using MRI imaging techniques is needed in order be able to fully characterize adenomyosis objectively and be sure of the diagnostic accuracy of these imaging modalities. ACKNOWLEDGEMENTS: We would like to thank bachelor student Iris Rupert for her help in the study screening and data extraction process.
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