Adenomyosis on MRI is characterized by a junctional zone (JZ) thickness. What is the current recommended diagnostic threshold for adenomyosis on MRI?
- A Junctional zone maximum thickness >8 mm is diagnostic of adenomyosis
- B Junctional zone maximum thickness >12 mm is diagnostic; 8–12 mm is indeterminate ✓
- C Junctional zone maximum thickness >20 mm is required for diagnosis
- D Junctional zone disruption on T2-weighted MRI without thickness threshold is the criterion
Correct answer: B. Junctional zone maximum thickness >12 mm is diagnostic; 8–12 mm is indeterminate
Explanation
Current MRI criteria for adenomyosis: junctional zone (JZ) maximum thickness >12 mm is diagnostic of adenomyosis on T2-weighted imaging. A JZ of 8–12 mm is indeterminate and requires additional features (JZ irregularity, myometrial cysts on T2, high-signal spots on T1 representing hemorrhagic foci). JZ <8 mm reliably excludes adenomyosis. These thresholds are from ESGE/ESHRE consensus. Ultrasound criteria (asymmetric myometrial thickening, myometrial cysts, fan-shaped shadowing) have lower specificity than MRI.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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