Department of Gynecology and Obstetrics, Catharina Hospital, Eindhoven, the Netherlands.
Department of Reproductive Medicine, Ghent University Hospital, Ghent, Belgium.
Acta Obstet Gynecol Scand. 2021 Aug;100(8):1377-1391. doi: 10.1111/aogs.14139. Epub 2021 Apr 4.
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.
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.
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 ratio-pooled 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.
A wide range of objective parameters for adenomyosis exist on MRI; however, in many cases their individual diagnostic performance remains uncertain. 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.
磁共振成像（MRI）诊断子宫腺肌病被认为是最准确的非侵入性技术，但仍然具有主观性，对于哪些诊断参数最准确尚无共识。我们旨在系统地综述文献，以了解如何在 MRI 上对子宫腺肌病进行客观量化，综述这些特征与组织病理学诊断相比的诊断性能，并总结 MRI 上子宫腺肌病测量值与临床结局之间的相关性。
我们根据 PRISMA 指南，在 Pubmed、Embase 和 Cochrane 数据库中检索截至 2020 年 4 月的相关文献。我们纳入了客观评估 MRI 上子宫腺肌病的研究，并分别评估了研究 MRI 与组织病理学比较的诊断性能，以纳入荟萃分析。使用 QUADAS-2 工具评估偏倚风险，许多研究显示出不确定或高偏倚风险。
共纳入 80 项研究，其中 14 项评估了 MRI 上的个别参数对子宫腺肌病的诊断性能，4 项研究纳入了诊断准确性的荟萃分析。常见的 MRI 参数包括：交界区（JZ）特征，如最大 JZ 厚度（综合敏感性 71.6%（95%CI 46.0%-88.2%），特异性 85.5%（52.3%-97.0%）；JZ 差异（综合敏感性 58.9%（95%CI 44.3%-72.1%），特异性 83.2%（95%CI 71.3%-90.8%）；JZ 与子宫肌层比值（综合敏感性 63.3%（95%CI 51.9%-73.4%），特异性 79.4%（95%CI 42.0%-95.4%）；子宫腺肌病病变大小，子宫形态（综合敏感性 42.9%（95%CI 15.9%-74.9%），特异性 87.7%（95%CI 37.9%-98.8%）和信号强度变化，例如存在子宫肌层囊肿；综合敏感性为 59.6%（95%CI 41.6%-75.4%）和特异性为 96.1%（95%CI 80.7%-99.3%）。其他 MRI 参数也用于子宫腺肌病的诊断，但它们的诊断性能尚不清楚。很少有研究试图将子宫腺肌病的 MRI 表型与临床结局相关联。
MRI 上存在广泛的子宫腺肌病客观参数，但在许多情况下，其单独的诊断性能仍然不确定。JZ 特征仍然是最广泛使用和研究的，具有可接受的诊断准确性。需要专门研究如何将这些子宫腺肌病的客观测量值与临床结局相关联。
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