{"paper_id":"69d96bc3-e2dc-4ccf-ac11-37c23022f185","body_text":"Abstract\nObjective\nTo evaluate the relationship between pelvic MRI findings and symptom presence in patients with leiomyoma and adenomyosis, and to determine whether these imaging parameters are independently associated with the presence of symptoms.\nMethods\nThis single-center retrospective study enrolled 150 patients who underwent pelvic MRI and were stratified into three groups based on pathological diagnosis: leiomyoma only (n = 75), adenomyosis only (n = 36), and concurrent pathology (n = 39). Leiomyoma assessment included International Federation of Gynecology and Obstetrics (FIGO) classification, maximum diameter, cavity distortion, and apparent diffusion coefficient (ADC) values; for adenomyosis, junctional zone (JZ) thickness and involvement pattern served as primary parameters. Composite MRI burden scores were constructed for each pathology. Imaging features independently associated with symptom presence were identified by binary logistic regression, and model discrimination was assessed with internal validation by bootstrap resampling.\nResults\nSymptom prevalence differed substantially across groups — 64.0% in the leiomyoma group, 72.2% in the adenomyosis group, and 97.4% in patients with concurrent pathology (p < 0.001). Each 1 mm increase in JZ thickness raised the odds ratio (OR) of symptoms 1.31-fold in the adenomyosis group (OR = 1.31; 95% confidence interval [CI]: 1.08–1.58; p = 0.006), with JZ thickness correlating with pelvic pain at r = 0.61. FIGO type 0–2 location was the imaging feature most strongly associated with abnormal uterine bleeding (AUB) among leiomyoma patients (OR = 6.82; 95% CI: 2.87–16.21; p < 0.001). ADC values were markedly lower in symptomatic leiomyomas (0.91 vs. 1.14 × 10⁻³ mm²/s; p < 0.001). The apparent area under the curve (AUC) was 0.809 for the symptom model and 0.821 for the AUB model, with optimism-corrected values of 0.785 and 0.796, respectively, on bootstrap internal validation.\nConclusion\nPelvic MRI findings in leiomyoma and adenomyosis are independently associated with the presence of symptoms, with JZ thickness, leiomyoma localization relative to the endometrial cavity, lesion size, and cavity distortion showing the strongest associations. Because these associations were derived and tested within a single cross-sectional sample, they should be regarded as hypothesis-generating and require prospective, externally validated confirmation before they can guide treatment decisions.\nAbbreviations\n- ADC:\n-\nApparent diffusion coefficient\n- AUB:\n-\nAbnormal uterine bleeding\n- AUC:\n-\nArea under the receiver operating characteristic curve\n- CI:\n-\nConfidence interval\n- DWI:\n-\nDiffusion-weighted imaging\n- FIGO:\n-\nInternational Federation of Gynecology and Obstetrics\n- IQR:\n-\nInterquartile range\n- JZ:\n-\nJunctional zone\n- JZdiff:\n-\nJunctional zone difference\n- JZmax:\n-\nMaximum junctional zone thickness\n- JZratio:\n-\nJunctional zone ratio\n- MRI:\n-\nMagnetic resonance imaging\n- OR:\n-\nOdds ratio\n- PALM-COEIN:\n-\nPolyp, Adenomyosis, Leiomyoma, Malignancy and hyperplasia – Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not yet classified\n- SPSS:\n-\nStatistical Package for the Social Sciences\n- TGF-β3:\n-\nTransforming growth factor beta 3\n- VIF:\n-\nVariance inflation factor\nAcknowledgements\nNot applicable. N/A.\nFunding\nThis study did not receive any financial support.\nAuthor information\nAuthors and Affiliations\nCorresponding author\nEthics declarations\nEthics approval and consent to participate\nThis study was approved by the Institutional Ethics Committee of Adiyaman University Training and Research Hospital (Approval No: 2026/2-45, Date: 24/03/2026). Given the retrospective design, the requirement for informed consent was waived by the Ethics Committee of Adiyaman University Training and Research Hospital.\nConsent for publication\nNot applicable. This study does not contain any identifying images, personal details, or clinical information of individual participants that could compromise anonymity.\nCompeting interests\nThe authors declare no competing interests.\nAdditional information\nPublisher’s note\nSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.\nRights and permissions\nOpen Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.\nAbout this article\nCite this article\nKaplan, S., Kaplan, E. Associations between pelvic MRI findings and symptom presence in uterine leiomyoma and adenomyosis: a quantitative analysis. BMC Women's Health (2026). https://doi.org/10.1186/s12905-026-04889-y\nReceived:\nAccepted:\nPublished:\nDOI: https://doi.org/10.1186/s12905-026-04889-y","source_license":"CC0","license_restricted":false}