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. 2023 Jun 28;13(13):2193.
doi: 10.3390/diagnostics13132193.

Inter-Rater Agreement for Diagnosing Adenomyosis Using Magnetic Resonance Imaging and Transvaginal Ultrasonography

Johanna K Andersson  1 , Raffaella Pozzi Mucelli  2   3 , Margit Dueholm  4 , Susanne Fridsten  3   5 , Aristeidis Grigoriadis  2   3 , Stefano Guerriero  6 , Francesco Paolo Leone  7 , Lil Valentin  8   9 , Thierry Van Den Bosch  10 , Nikolaos Voulgarakis  2   3 , Kristina Gemzell-Danielsson  11 , Elisabeth Epstein  12   13
Affiliations

Inter-Rater Agreement for Diagnosing Adenomyosis Using Magnetic Resonance Imaging and Transvaginal Ultrasonography

Johanna K Andersson et al. Diagnostics (Basel). .

Abstract

Our aim was to compare the inter-rater agreement about transvaginal ultrasonography (TVS) with magnetic resonance imaging (MRI) with regard to diagnosing adenomyosis and for assessing various predefined imaging features of adenomyosis, in the same set of women. The study cohort included 51 women, prospectively, consecutively recruited based on a clinical suspicion of adenomyosis. MRIs and TVS videoclips and 3D volumes were retrospectively assessed by four experienced radiologists and five experienced sonographers, respectively. Each rater subjectively evaluated the presence or absence of adenomyosis, as well as imaging features suggestive of adenomyosis. Fleiss kappa (κ) was used to reflect inter-rater agreement for categorical data, and the intraclass correlation coefficient (ICC) was used to reflect the reliability of quantitative data. Agreement between raters for diagnosing adenomyosis was higher for TVS than for MRI (κ = 0.42 vs. 0.28). MRI had a higher inter-rater agreement in assessing wall asymmetry, irregular junctional zone (JZ), and the presence of myometrial cysts, while TVU had a better agreement for assessing globular shape. MRI showed a moderate to good reliability for measuring the JZ (ICC = 0.57-0.82). For TVS, the JZ was unmeasurable in >50% of cases, and the remaining cases had low reliability (ICC = -0.31-0.08). We found that inter-rater agreement for diagnosing adenomyosis was higher for TVS than for MRI, despite the fact that MRI showed a higher inter-rater agreement in most specific features. Measurements of JZ in the coronal plane with 3D TVS were unreliable and thus unlikely to be useful for diagnosing adenomyosis.

Keywords: adenomyosis; inter-rater agreement; magnetic resonance imaging; ultrasonography.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
(a,b). MRI features of adenomyosis: T2-weighted sagittal images from two different subjects with adenomyosis. (a). JZmax, the thickest part of the JZ in the midsagittal plane (orange arrow). JZmin, the thinnest part of the JZ in the midsagittal plane (green arrow). Myometrial thickness, measured at the same level as JZmax (orange dotted arrow). (b). Example of a uterus with globular shape and asymmetric thickening of JZ (anterior JZ thicker than posterior JZ). The JZ is irregular due to the presence of multiple hyperintense cystic foci within the thickened JZ.
Figure 2
Figure 2
(A,B). TVS measurements and features in women with adenomyosis. (A) Measurement of (a) uterine anterio-posterior diameter, (b) anterior-, and (c) posterior uterine wall thickness in the longitudinal plane. Junctional zone (white arrow), measurement inthe 3D reconstructed coronal plane. (B) Examples of sonographic features of adenomyosis.
Figure 2
Figure 2
(A,B). TVS measurements and features in women with adenomyosis. (A) Measurement of (a) uterine anterio-posterior diameter, (b) anterior-, and (c) posterior uterine wall thickness in the longitudinal plane. Junctional zone (white arrow), measurement inthe 3D reconstructed coronal plane. (B) Examples of sonographic features of adenomyosis.
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