Adenomyosis: specificity of 5 mm as the maximum normal uterine junctional zone thickness in MR images
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This study found that a junctional zone thickness greater than 5 mm in uterine MR images occurred in 65% of women without adenomyosis, suggesting 5 mm is not a reliable upper limit of normal for diagnosis.
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Abstract
OBJECTIVE: Our objective was to investigate the specificity of the criterion stating that a diagnosis of adenomyosis can be made confidently from MR images of the uterus when the junctional zone is thicker than 5 mm.
SUBJECTS AND METHODS: Twenty clinically normal women volunteers (chosen by strict criteria) underwent MR imaging of the uterus. Images were independently evaluated by two experienced observers who measured the greatest thickness of the junctional zone in the anterior, posterior, right and left walls of the uterine corpus and at the top of the fundus.
RESULTS: The mean value of the greatest junctional zone thickness (averaged for both observers) was 4.4 +/- 2.1 mm (mean +/- SD, range, 1-9 mm) for the anterior and posterior walls of the corpus, 4.3 +/- 2.1 mm (range, 1-10 mm) for the right and left walls, and 2.3 +/- 1.1 mm (range, 1-5 mm) for the fundus. At least one region of the junctional zone was found to be thicker than 5 mm by at least one observer in 13 (65%) of the 20 subjects; at least one region was found to be thicker than 5 mm by both observers in eight (40%) subjects. At least two regions were measured as thicker than 5 mm by both observers in six (30%) subjects. Serial studies of three volunteers showed transient irregular focal or diffuse thickening (up to 12 mm) of the junctional zone and focal myometrial bulging, probably due to myometrial contractions.
CONCLUSION: Our results suggest that if a diagnosis of adenomyosis is based solely on junctional zone thickness in MR images, 5 mm should not be assumed as the upper limit of normal, because this assumption may result in a high false-positive rate.
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Cited by (35)
- Objective measures of adenomyosis on MRI and their diagnostic accuracy-a systematic review & meta-analysis 2021
- TAS/TVS versus histopathological diagnosis in abnormal uterine bleeding: A comparative study 2020
- Diagnosing adenomyosis with MRI: a prospective study revisiting the junctional zone thickness cutoff of 12 mm as a diagnostic marker 2019
- Faculty Opinions recommendation of MRI for adenomyosis: a pictorial review. 2019
- Role of transvaginal sonography and magnetic resonance imaging in the diagnosis of uterine adenomyosis 2018
- The uterine junctional zone of endoand myometrium: morphofunctional features and importance in obstetric and gynecologic pathogenic mechanism 2017
- MRI for adenomyosis: a pictorial review 2017
- Repeatability of Junctional Zone Measurements Using 3-Dimensional Transvaginal Sonography in Healthy Fertile Women 2016
- Junctional zone thickness in young nulliparous women according to menstrual cycle and hormonal contraception use 2016
- Diagnostic findings in adenomyosis: a pictorial review on the major concerns 2015
- [Uterine adenomyosis, clinical and therapeutic study: about 87 cases] 2015
- Diagnóstico de la adenomiosis 2014
- MRI characteristics of the uterine junctional zone: from normal to the diagnosis of adenomyosis 2011
- Adenomiose em pacientes com endometriose profunda: aspectos clínicos, histológicos e radiológicos 2010
- Mesenchymal uterine tumors, other than pure smooth muscle neoplasms, and adenomyosis 2009
- Adenomyosis and 'endometrial-subendometrial myometrium unit disruption disease' are two different entities 2008
- Adenomyose 2008
- Effectiveness of the levonorgestrel-releasing intrauterine system in the treatment of adenomyosis diagnosed and monitored by magnetic resonance imaging 2007
- Adenomyosis 2007
- Adenomyosis as a disorder of the early and late human reproductive period 2007
- Spectrum of MR features in adenomyosis 2006
- Imaging diagnosis of adenomyosis 2005
- MR imaging findings of adenomyosis: correlation with histopathologic features and diagnostic pitfalls 2005
- Imagerie de l'adénomyose 2005
- Imagerie de l'adénomyose 2005
- [Adenomyosis: what imaging modality in the diagnosis and staging?] 2004
- Endokrine operative Therapie der Adenomyosis 2004
- Adenomyosis: MRI of the uterus treated with uterine artery embolization 2003
- Uterine adenomyosis in the infertility clinic 2003
- Radiographic imaging techniques for the diagnosis of abnormal uterine bleeding 2000
- Adenomyosis: difficult to diagnose, and difficult to treat 2000
- Transient uterine contraction mimicking adenomyosis on MRI 1998
- Imaging features of adenomyosis 1998
- Case report Transient uterine contraction mimicking adenomyosis on MRI 1998
- Surgical and medical treatment of adenomyosis 1998
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