What are the most reliable signs for the radiologic diagnosis of uterine adenomyosis? An ultrasound and MRI prospective

Hamimi, Ahmed

doi:10.1016/j.ejrnm.2015.09.007

Cited by 6 publications

(5 citation statements)

References 25 publications

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“…For patient flow and timing, most studies did not provide enough information to assess this domain properly. Hamimi et al 14 had a high risk of bias on this domain as not all patients received the same reference standard diagnosis. Two studies 14,18 were arguably less applicable with regards to the analysis of diagnostic accuracy.…”

Section: Resultsmentioning

confidence: 99%

“…A graphical summary of the quality assessment is shown in Figure 2, as well as the assessment per included study in Figure 3. In the domain of patient selection, two studies were deemed to have a high risk of bias because of their retrospective design and/or unclear exclusion criteria 13,14 . For the index test domain (MRI), two studies had a high risk of bias, as no definition of adenomyosis before MRI evaluation was reported 15,16 .…”

Section: Resultsmentioning

confidence: 99%

“…Hamimi et al 14 had a high risk of bias on this domain as not all patients received the same reference standard diagnosis. Two studies 14,18 were arguably less applicable with regards to the analysis of diagnostic accuracy. Hamimi et al did not compare the index test to histopathological diagnosis in many cases, and Phillips et al only investigated the diagnostic performance of MRI in relation to adenomyomas, and not adenomyosis generally.…”

Section: Resultsmentioning

confidence: 99%

“…In the domain of patient selection, two studies were deemed to have a high risk of bias because of their retrospective design and/or unclear exclusion criteria. 13,14 For the index test domain (MRI), two studies had a high risk of bias, as no definition of adenomyosis before MRI evaluation was reported. 15,16 As for the reference standard domain, many studies did not clearly report if pathologists were blinded.…”

Section: Methodological Quality Of Included Studiesmentioning

confidence: 99%

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Objective measures of adenomyosis on MRI and their diagnostic accuracy—a systematic review & meta‐analysis

Rees

Mischi

Vliet

et al. 2021

Acta Obstet Gynecol Scand

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Introduction: Magnetic resonance imaging (MRI) diagnosis of adenomyosis is considered the most accurate non-invasive technique, but remains subjective, with no consensus on which diagnostic parameters are most accurate. We aimed to systematically review the literature on how adenomyosis can be objectively quantified on MRI in a scoping manner, to review the diagnostic performance of these characteristics compared with histopathological diagnosis, and to summarize correlations between measures of adenomyosis on MRI and clinical outcomes. Material and methods:We searched databases Pubmed, Embase, and Cochrane for relevant literature up to April 2020 according to PRISMA guidelines. We included studies that objectively assessed adenomyosis on MRI, and separately assessed studies investigating the diagnostic performance of MRI vs histopathology for inclusion in a meta-analysis. The QUADAS-2 tool was used for risk of bias, with many studies showing an unclear or high risk of bias.Results: Eighty studies were included, of which 14 assessed the diagnostic performance of individual MRI parameters, with four included in the meta-analysis of diagnostic accuracy. Common MRI parameters were: junctional zone (JZ) characteristics, such as maximum JZ thickness-pooled sensitivity 71.6% (95% CI 46.0%-88.2%), specificity 85.5% (52.3%-97.0%); JZ differential-pooled sensitivity 58.9% (95% CI 44.3%-72.1%), specificity 83.2% (95% CI 71.3%-90.8%); and JZ to myometrial ratiopooled sensitivity 63.3% (95% CI 51.9%-73.4%), specificity 79.4% (95% CI 42.0%-95.4%); adenomyosis lesion size, uterine morphology (pooled sensitivity 42.9% (95% CI 15.9%-74.9%), specificity 87.7%, (95% CI 37.9-98.8) and changes in signal intensity-eg, presence of myometrium cysts; pooled 59.6% (95% CI 41.6%-75.4%) and specificity of 96.1% (95% CI 80.7%-99.3%). Other MRI parameters have been used for adenomyosis diagnosis, but their diagnostic performance is unknown. Few studies attempted to correlate adenomyosis MRI phenotype to clinical outcomes. Conclusions:A wide range of objective parameters for adenomyosis exist on MRI; however, in many cases their individual diagnostic performance remains uncertain.We included studies investigating the diagnosis, evaluation or classification of adenomyosis objectively based on MRI. Studies were included regardless of study design, use of hormonal therapy, age, or clinical manifestation. Studies written in English, Dutch or French were considered for inclusion, published up to April 7, 2020.Data reported in secondary analysis (reviews), case reports, letters to editors, conference abstracts, and protocols for ongoing JZ characteristics remain the most widely used and investigated with acceptable diagnostic accuracy. Specific research is needed into how these objective measures of adenomyosis can be correlated to clinical outcomes.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Methodological Quality Of Included Studiesmentioning

confidence: 99%

See 2 more Smart Citations

Objective measures of adenomyosis on MRI and their diagnostic accuracy—a systematic review & meta‐analysis

Rees

Mischi

Vliet

et al. 2021

Acta Obstet Gynecol Scand

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“…41 This meta-analysis pooled data from 4 studies for the criteria of JZ thickness ≥12 mm and found that the study by Tellum et al 40 reported a much lower diagnostic accuracy (54%) when compared with the other pooled studies (85-95%). 19,21,57 This variation may in part be attributed to the different methods of measuring JZ thickness. Tellum et al 40 included only the low-signal intensity band on T2W images of the inner myometrium, excluding areas of focal and diffuse adenomyosis, whereas other investigators included the focal or diffuse adenomyomatous lesion in the measurements of JZ thickness as is standard practice since these blend with and are often indistinguishable from the JZ.…”

Section: Mri Technique and Imaging Features Of Adenomyosismentioning

confidence: 99%

MRI of Adenomyosis: Where Are We Today?

et al. 2022

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Purpose of Review: The purpose of this review is to (i) summarize the current literature regarding the role of magnetic resonance imaging (MRI) in diagnosing adenomyosis, (ii) examine how to integrate MRI phenotypes with clinical symptomatology and histological findings, (iii) review recent advances including proposed MRI classifications, (iv) discuss challenges and pitfalls of diagnosing adenomyosis, and (v) outline the future role of MRI in promoting a better understanding of the pathogenesis, diagnosis, and treatment options for patients with uterine adenomyosis. Recent Findings: Recent advances and the widespread use of MRI have provided new insights into adenomyosis and the range of imaging phenotypes encountered in this disorder. Summary: Direct and indirect MRI features allow for accurate non-invasive diagnosis of adenomyosis. Adenomyosis is a complex and poorly understood disorder with variable MRI phenotypes that may be correlated with different pathogeneses, clinical presentations, and patient outcomes. MRI is useful for the assessment of the extent of findings, to evaluate for concomitant gynecological conditions, and potentially can help with the selection and implementation of therapeutic options. Nevertheless, important gaps in knowledge remain. This is in part due to the lack of standardized criteria for reporting resulting in heterogeneous and conflicting data in the literature. Thus, there is an urgent need for a unified MRI reporting system incorporating standardized terminology for diagnosing adenomyosis and defining the various phenotypes.

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