Junctional zone thickness on magnetic resonance imaging –⁠ a non-invasive diagnostic method for adenomyosis and beyond

Czech version

Authors: Jule Eriç Horasanl ¹; Fatih Akkuş ²; Pinar Diydem Yılmaz ³; Cengiz Kadıyoran ³; Ecenur Çetinkuş Polat ¹
Authors‘ workplace: Department of Obstetrics and Gynecology, Necmettin Erbakan University Faculty of Medicine, Konya, Turkey ¹; Department of Obstetrics, Gynecology and Perinatology, Kütahya City Hospital, Kütahya, Turkey ²; Department of Radiology, Faculty of Medicine, Necmettin Erbakan University Faculty of Medicine, Konya, Turkey ³
Published in: Ceska Gynekol 2026; 91(3): 173-180
Category: Original Article
doi: https://doi.org/10.48095/cccg2026173

Overview

Background and objectives: Adenomyosis is a prevalent gynecologic disorder involving ectopic endometrial tissue within the myometrium. Magnetic resonance imaging (MRI) enables non-invasive diagnosis, yet the role of junctional zone (JZ) thickness in predicting coexisting intrauterine pathologies remains uncertain. This study evaluated the diagnostic and predictive value of MRI-based JZ thickness in hysterectomy-confirmed adenomyosis. Materials and methods: This retrospective study included 420 patients who underwent hysterectomy with preoperative MRI between 2020 and 2025. JZ thickness was measured on sagittal T2-weighted images, and histopathological findings were recorded. Logistic regression analyses were performed to identify independent predictors of intrauterine pathologies. Diagnostic accuracy was assessed using receiver operating characteristic (ROC) curves. Results: The mean JZ thickness was 17.5 ± 3.8 mm. Histopathological evaluation confirmed adenomyosis in 97.1% of cases, with coexisting lesions including myomas (44.5%), endometrial polyps (7.9%), simple hyperplasia (6.2%), atypical hyperplasia (1.9%), and endometrial cancer (2.4%). JZ thickness demonstrated strong positive correlations with polyps (R = 0.46; P < 0.001), simple hyperplasia (R = 0.55; P < 0.001), atypical hyperplasia (R = 0.49; P < 0.001), and myomas (R = 0.38; P < 0.001). Logistic regression identified JZ thickness as the most consistent independent predictor of intrauterine lesions, with an odds ratio of 1.70 for atypical hyperplasia (95% CI 1.11–2.60; P = 0.014). ROC analysis revealed excellent discriminative ability for simple hyperplasia (AUC = 0.842), atypical hyperplasia (AUC = 0.888), and polyps (AUC = 0.840), while predictive performance for myomas was moderate (AUC = 0.661). Conclusions: MRI-based measurement of JZ thickness is a reliable, non-invasive biomarker for adenomyosis, demonstrating an additional predictive value for coexisting premalignant intrauterine pathologies. Incorporating JZ thickness thresholds into routine imaging evaluation may enhance risk stratification, reduce unnecessary invasive procedures, and inform about personalized management strategies in women with adenomyosis.

Keywords:

adenomyosis – magnetic resonance imaging – junctional zone – non-invasive diagnosis

Sources

1. Gordts S, Grimbizis G, Campo R. Symptoms and classification of uterine adenomyosis, including the place of hysteroscopy in diagnosis. Fertil Steril 2018; 109 (3): 380.e1–388.e1. doi: 10.1016/j.fertnstert.2018.01.006.

2. Vannuccini S, Petraglia F. Recent advances in understanding and managing adenomyosis. F1000Res 2019; 8: F1000 Faculty Rev-283. doi: 10.12688/f1000research.17242.1.

3. Guo SW. The pathogenesis of adenomyosis vis-à-vis endometriosis. J Clin Med 2020; 9 (2): 485. doi: 10.3390/jcm9020485.

4. Struble J, Reid S, Bedaiwy MA. Adenomyosis: a clinical review of a challenging gynecologic condition. J Minim Invasive Gynecol 2016; 23 (2): 164–185. doi: 10.1016/j.jmig.2015.09.018.

5. Abbott JA. Adenomyosis and abnormal uterine bleeding (AUB-A) –⁠ pathogenesis, diagnosis, and management. Best Pract Res Clin Obstet Gynaecol 2017; 40 : 68–81. doi: 10.1016/j.bpobgyn.2016.09.006.

6. Chapron C, Vannuccini S, Santulli P et al. Diagnosing adenomyosis: an integrated clinical and imaging approach. Hum Reprod Update 2020; 26 (3): 392–411. doi: 10.1093/humupd/dmz049.

7. Novellas S, Chassang M, Delotte J et al. MRI characteristics of the uterine junctional zone: from normal to the diagnosis of adenomyosis. AJR Am J Roentgenol 2011; 196 (5): 1206–1213. doi: 10.2214/AJR.10.4877.

8. Harmsen MJ, Trommelen LM, de Leeuw RA et al. Uterine junctional zone and adenomyosis: comparison of MRI, transvaginal ultrasound and histology. Ultrasound Obstet Gynecol 2023; 62 (1): 42–60. doi: 10.1002/uog.26117.

9. Bergholt T, Eriksen L, Berendt N et al. Prevalence and risk factors of adenomyosis at hysterectomy. Human Reprod 2001; 16 (11): 2418–2421. doi: 10.1093/humrep/16.11.2418.

10. Templeman C, Marshall SF, Ursin G et al. Adenomyosis and endometriosis in the California Teachers Study. Fertil Steril 2008; 90 (2): 415–424. doi: 10.1016/j.fertnstert.2007.06.027.

11. Bergholt T, Eriksen L, Berendt N et al. Prevalence and risk factors of adenomyosis at hysterectomy. Human Reprod 2001; 16 (11): 2418–2421. doi: 10.1093/humrep/16.11.2418.

12. Leyendecker G, Wildt L, Mall G. The pathophysiology of endometriosis and adenomyosis: tissue injury and repair. Arch Gynecol Obstet 2009; 280 (4): 529–538. doi: 10.1007/s00404-009-1191-0.

13. Tetikkurt S, Çelik E, Taş H et al. Coexistence of adenomyosis, adenocarcinoma, endometrial and myometrial lesions in resected uterine specimens. Mol Clin Oncol 2018; 9 (2): 231–237. doi: 10.3892/mco.2018.1660.

14. Molitor JJ. Adenomyosis: a clinical and pathologic appraisal. Am J Obstet Gynecol 1971; 110 (2): 275–284. doi: 10.1016/0002-9378 (71) 90620-x.

15. Shrestha A, Shrestha R, Sedhai LB et al. Adenomyosis at hysterectomy: prevalence, patient characteristics, clinical profile and histopatholgical findings. Kathmandu Univ Med J (KUMJ) 2012; 10 (37): 53–56. doi: 10.3126/kumj.v10i1.6915.