93 Introduction Adenomyosis is a benign uterine disorder which is defined by the existence of endometrial glands and stroma within the myometrium, initiating hypertrophy and hyperplasia of the surrounding smooth muscle cells (200). This condition can lead to detrimental symptoms, such as dysmenorrhea and infertility. Besides, adenomyosis might influence reproductive outcomes and is linked to pregnancy complications such as placental insufficiency. Adenomyosis exists in approximately 10% of the women of reproductive age and in 30 to 50% of women with infertility (81). Alongside physical complaints, a higher risk of depression and anxiety and a poorer quality of life in patients with adenomyosis have been demonstrated . Non-invasive diagnosis of adenomyosis remains challenging. Until relatively recently, adenomyosis could only be diagnosed through histology after hysterectomy (201). This can cause diagnostic delay, since this invasive procedure is commonly performed in women in their late reproductive years (200). Clinically, the diagnosis of adenomyosis can be presumed, however it is difficult to determine due to the nonspecific symptoms and a fraction of women being asymptomatic (202). Considering the physical and mental burden and consequences of adenomyosis on women, it is absolutely valuable to diagnose this condition in a timely fashion. Previous studies have demonstrated that adenomyosis can be diagnosed using less invasive methods, such as Magnetic Resonance Imaging (MRI) and transvaginal ultrasound (TVUS) (33,181). Although, there are TVUS diagnostic criteria available for adenomyosis diagnosis, such as the MUSA criteria, the reliability is dependent on the experience of the sonographer (30,185). Compared to TVUS, MRI is considered to be the most accurate of these methods (34). Various parameters on MRI have been investigated that can be used to characterize adenomyosis, such as junctional zone thickness, myometrial signal intensity and uterine size (33). Despite great efforts to create a non-invasive classification system for adenomyosis on MRI, there is as yet no clinically implemented tool for the prediction of adenomyosis diagnosis (16,43,203). Nevertheless, reliable imaging diagnostic classification systems are lacking and the diagnostic process of adenomyosis therefore remains a challenge (19).
RkJQdWJsaXNoZXIy MTk4NDMw