Evaluation of Junctional Zone Differential and Ratio as Possible Markers of Clinical Efficacy in Uterine Artery Embolization of Adenomyosis

Abstract Introduction Uterine artery embolization is a well-established method of adenomyosis treatment. Changes in uterine volume and maximal junctional zone thickness (JZmax) after embolization are thoroughly analyzed in the literature. Changes in other suggested morphological diagnostic markers of adenomyosis (junctional zone differential – JZdiff - and junctional zone ratio - JZratio) on the other hand are rarely evaluated. This single-center retrospective study aimed to analyze the changes in morphological parameters used for the MR imaging diagnosis of adenomyosis (including JZdiff and JZratio) after UAE. Clinical effectiveness and safety were also analyzed. Materials and methods Patients who underwent UAE for adenomyosis from 2008-2021 were evaluated. Adenomyosis was diagnosed based on JZmax, JZdiff, and JZratio measured on MR imaging. To assess clinical efficacy numerical-analog-quality-of-life (QoL) score was routinely obtained from patients at our centre. MRI morphological data were analyzed. Wilcoxon signed-rank test, uni- and multivariate regression models, Pearson product-moment correlation, and Kruskal-Wallis tests were used for statistical analysis. Results From our database of 801 patients who underwent UAE in 14 years, preprocedural MR images were available in 577 cases, 15 patients had pure adenomyosis (15/577, 2.6%). Uterine volume, JZmax, and JZdiff decreased significantly after UAE; QoL score increased significantly. A significant correlation was found between QoL change vs. JZmax and JZdiff change. Permanent amenorrhoea and elective hysterectomy 5 years after UAE were both 7.1%. Conclusion Change of JZdiff after UAE in adenomyis is a potential marker of clinical success. UAE is clinically safe and effective treatment in adenomyosis. Level of Evidence: Level 4, Case Series.