Investigation of the effect of volumetric characteristics of the uterus in magnetic resonance imaging on symptom prediction in adenomyosis cases

Adenomyosis is a disorder characterized by the presence of endometrial tissue within the myometrium. While clinical history is the first step in diagnosis, imaging is required for confirmation. Ultrasonography and magnetic resonance imaging (MRI) are the most frequently used methods. Previous studies have examined the association between adenomyosis volume and related symptoms, as well as comparisons between imaging techniques. However, it remains unclear whether symptom severity is more closely related to absolute lesion size or its proportion within the uterus. This study aimed to compare uterine volume values obtained by MRI and the ratios derived from them in predicting clinical symptoms, in order to determine which parameters best reflect the relationship between symptomatology and anatomical structure. A retrospective cohort design was used. Medical records of reproductive-aged women (18–50 years) who underwent MRI for suspected adenomyosis at Karadeniz Technical University, Faculty of Medicine, Farabi Hospital, Department of Obstetrics and Gynecology between 2023 and 2024 were reviewed. Data on pain status, bleeding patterns, and infertility were collected. Adenomyosis and uterine volumes were measured using ImageJ software, and ratios were calculated. Statistical analyses were performed with SPSS. The ratio of adenomyosis volume to total uterine volume emerged as the strongest predictor of clinical symptoms, particularly bleeding intensity, number of pads used daily, and pain during and after menstruation. Each unit increase in this ratio was associated with a 23.018-point rise in the Pelvic Pain Impact Questionnaire score and a 17.384-unit increase in pad usage. These findings suggest that, in three-dimensional MRI evaluations, considering the proportion of uterine volume occupied by adenomyosis provides more clinically meaningful insight into symptom severity than absolute volumes alone. Given the challenge of identifying pure adenomyosis cases, larger multicenter studies are needed to clarify the clinical implications of this relationship.