Coexistence and Correlation of Adenomyosis, DIE and Ovarian Endometrioma Size: Insights from MR

INTRODUCTION: The coexistence of ovarian endometriomas, adenomyosis, and deep infiltrating endometriosis (DIE) is frequently observed in endometriosis. This study aimed to investigate the relationship between endometrioma size and the presence of adenomyosis and DIE on pelvic MRI, as well as the association between adenomyosis and DIE, and to assess whether endometrioma size could serve as a marker for these conditions.
METHODS: This retrospective single-center study included 118 women with ovarian endometriomas who underwent pelvic MRI between January 2019-January 2023. The presence of adenomyosis and DIE was recorded based on standardized MRI criteria. The largest endometrioma diameter was measured for each patient. Statistical analyses included Kruskal–Wallis tests for group comparisons, point-biserial correlations to assess the relationship between endometrioma size and adenomyosis/DIE, and Chi-square tests to evaluate the association between adenomyosis and DIE.
RESULTS: Ovarian endometrioma size was not significantly associated with adenomyosis or DIE. Median endometrioma diameters did not differ significantly between patients with and without adenomyosis or DIE (all p>0.05). In contrast, there was a strong association between adenomyosis and DIE: adenomyosis was present in 27 of 74 women with DIE (36.5%) compared with only 4 of 44 women without DIE (9.1%). Chi-square testing confirmed this relationship (p=0.001), and symmetric measures indicated a moderate positive correlation (r=0.301, p=0.001).
DISCUSSION AND CONCLUSION: Ovarian endometrioma size does not appear to predict adenomyosis or DIE; however, the coexistence of adenomyosis and DIE is significant and clinically relevant. Identification of adenomyosis on MRI should prompt careful evaluation for concurrent DIE, as this combination may reflect a more severe endometriosis phenotype.

Keywords: Endometriosis, Deep infiltrating endometriosis, Adenomyosis, Ovarian endometrioma, Magnetic resonance imaging, Pelvic imaging