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

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 accurate. We aimed to systematically review literature how can be objectively quantified MRI in a scoping manner, performance these characteristics compared histopathological diagnosis, and summarize correlations between measures clinical outcomes. Material methods searched databases Pubmed, Embase, Cochrane for relevant up April 2020 according PRISMA guidelines. included studies that assessed MRI, separately investigating vs histopathology inclusion meta-analysis. The QUADAS-2 tool was used risk bias, many showing an unclear or high bias. Results Eighty were included, 14 individual parameters, four meta-analysis accuracy. Common 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%); differential—pooled 58.9% 44.3%–72.1%), 83.2% 71.3%–90.8%); myometrial ratio—pooled 63.3% 51.9%–73.4%), 79.4% 42.0%–95.4%); lesion size, uterine morphology (pooled 42.9% 15.9%–74.9%), 87.7%, 37.9–98.8) changes signal intensity—eg, presence myometrium cysts; pooled 59.6% 41.6%–75.4%) 96.1% 80.7%–99.3%). Other have been their unknown. Few attempted correlate phenotype Conclusions A wide range objective exist MRI; however, cases uncertain. remain widely investigated acceptable Specific research needed into correlated