95 Methods Study Design This study was designed to be a single-centre, observational, retrospective cohort study. This geographical external validation study used data from ‘Medisch Spectrum Twente (MST)’ located in Enschede, a regional nonacademic teaching hospital in the Netherlands. Patient selection and Data Sources Patients were included if they had undergone a hysterectomy on suspicion of benign pathology with a pre-operative pelvic MRI. Patients without an available pre-operative pelvic MRI were excluded. This study also excluded patients if a different MRI protocol was used and if no pathology rapport was available after hysterectomy. Furthermore, patients were excluded if they had (suspicion of) a gynaecological malignancy or if they did not want their information to be used. The developed model included data of patients who had undergone surgery between January 2007 and January 2022. The dataset of this external validation study provided by the MST hospital included data of patients who had undergone surgery between January 2014 and January 2022. Patients were selected through screening based on electronic search queries in CTcue (CTcue BV, Amsterdam, the Netherlands) (see appendix 4A for further specification). Clinical characteristics were collected from the electronic hospital information system Healthcare Information eXchange (HiX) (ChipSoft BV, Amsterdam, the Netherlands). Study Outcomes The primary outcome was the histopathological diagnosis of adenomyosis after hysterectomy. Secondary outcomes included the characterisation of various MRI parameters of confirmed adenomyosis patients. Also, clinical parameters such as age, BMI, associated conditions such as endometriosis and relevant symptoms were evaluated. Data Extraction and MRI Assessment The imaging data were independently examined by two investigators from the Catharina Hospital Eindhoven blinded to the outcome of the pathology reports. The following baseline characteristics were retrospectively extracted
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