On MRI, adenomyosis is characterized by which of the following features?

• A Low-signal intensity myometrial lesion with clear margins on T2-weighted imaging
• B High-signal intensity uterine lesion on T1-weighted imaging with peripheral enhancement
• C Intracavitary lesion distorting the endometrial stripe on T2
• D Thickening and low signal of the junctional zone (JZ ≥12 mm) on T2-weighted imaging ✓

Explanation

On MRI T2-weighted imaging, the junctional zone (JZ) — the innermost layer of myometrium — is normally ≤8 mm. In adenomyosis, JZ thickening ≥12 mm is the most reliable diagnostic criterion (sensitivity 85%, specificity 96%). The JZ appears as a low-signal area due to compact smooth muscle and sparse glands. The diagnosis is confirmed when JZ maximum minus minimum exceeds 5 mm (heterogeneous thickening). High T1 signal foci within a thickened JZ represent hemorrhagic ectopic endometrial glands and are specific for adenomyosis.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.