title: Adenomyosis: specificity of 5 mm as the maximum normal uterine junctional zone thickness in MR images.
abstract: OBJECTIVE
  Our objective was to investigate the specificity of the criterion stating that a diagnosis of adenomyosis can be made confidently from MR images of the uterus when the junctional zone is thicker than 5 mm.
  
  
  METHODS
  Twenty clinically normal women volunteers (chosen by strict criteria) underwent MR imaging of the uterus. Images were independently evaluated by two experienced observers who measured the greatest thickness of the junctional zone in the anterior, posterior, right and left walls of the uterine corpus and at the top of the fundus.
  
  
  RESULTS
  The mean value of the greatest junctional zone thickness (averaged for both observers) was 4.4 +/- 2.1 mm (mean +/- SD, range, 1-9 mm) for the anterior and posterior walls of the corpus, 4.3 +/- 2.1 mm (range, 1-10 mm) for the right and left walls, and 2.3 +/- 1.1 mm (range, 1-5 mm) for the fundus. At least one region of the junctional zone was found to be thicker than 5 mm by at least one observer in 13 (65%) of the 20 subjects; at least one region was found to be thicker than 5 mm by both observers in eight (40%) subjects. At least two regions were measured as thicker than 5 mm by both observers in six (30%) subjects. Serial studies of three volunteers showed transient irregular focal or diffuse thickening (up to 12 mm) of the junctional zone and focal myometrial bulging, probably due to myometrial contractions.
  
  
  CONCLUSIONS
  Our results suggest that if a diagnosis of adenomyosis is based solely on junctional zone thickness in MR images, 5 mm should not be assumed as the upper limit of normal, because this assumption may result in a high false-positive rate.
authors.affiliation: Department of Diagnostic Radiology and Nuclear Medicine, Rush Medical College, Chicago, IL 60612, USA.
authors.forename: S
authors.initials: S
authors.lastname: Kang
authors.forename: D A
authors.initials: DA
authors.lastname: Turner
authors.forename: G S
authors.initials: GS
authors.lastname: Foster
authors.forename: M I
authors.initials: MI
authors.lastname: Rapoport
authors.forename: S A
authors.initials: SA
authors.lastname: Spencer
authors.forename: J Z
authors.initials: JZ
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D004715:Endometriosis / Q000175:diagnosis*; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D008597:Menstrual Cycle; D015588:Observer Variation; D012016:Reference Values; D012680:Sensitivity and Specificity; D014591:Uterine Diseases / Q000175:diagnosis*; D014599:Uterus / Q000033:anatomy & histology*