VP62.34: Objective measures of adenomyosis on MRI and their diagnostic accuracy: a systematic review and meta‐analysis

Systematically review existing literature on how adenomyosis can be objectively quantified on MRI and review the diagnostic performance of these objective characteristics compared to histopathological diagnosis. 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 from within those, separately assessed studies which investigated the diagnostic performance of MRI versus histopathology. A meta analysis was carried to calculate pooled sensitivities and specificities of MRI diagnostic parameters, and we used the QUADAS-2 tool to assess risk of bias. Of 1,713 screened records, 80 studies met eligibility criteria and were included in this review, of which 14 assessed the diagnostic performance of individual MRI parameters. Overall, MRI was shown to have varying sensitivity (range 39–89%, pooled 79.1%) and generally high specificity (range 53–100%, pooled 91.9%) for adenomyosis diagnosis, however the quality of studies varied. The most commonly evaluated objective MRI parameters were: junctional zone characteristics (56 studies, e.g. maximal JZ thickness, JZ differential and JZ to myometrial ratio), uterine size and morphology (35 studies, e.g. uterine volume or uterine wall asymmetry) and changes in signal intensity (7 studies, e.g. number of high signal intensity foci, signal intensity of adenomyosis tissue versus normal myometrial tissue). The diagnostic performance of many of these parameters has not been investigated, and 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. Specific research is needed into how objective measures of adenomyosis can be correlated to clinical outcomes.