Updates in ultrasound imaging of adenomyosis and clinical impacts

Adenomyosis is characterized by the presence of ectopic endometrial glands and tissue within the myometrium. The diagnosis and detection of adenomyosis on imaging have been hindered by a lack of consensus among clinicians and the historical view that diagnosis can only be made through histopathology posthysterectomy. The purpose of this review is to discuss updates in imaging findings for adenomyosis and summarize the current literature regarding ultrasonography.

The Morphological Uterus Sonographic Assessment consensus published in 2015, with updates in 2018 and 2022, has provided novel criteria for ultrasound diagnosis of adenomyosis. Studies comparing ultrasound with MRI have found that these imaging methodologies have similar sensitivity, specificity, and accuracy. However, concerns remain about the repeatability and reproducibility of these features in ultrasound imaging. There is a strong need for universal adoption to enhance ultrasound reporting and access for adenomyosis.

Transvaginal ultrasonography is a widely available, time- and cost-effective imaging modality with excellent detection rates of adenomyosis. Common terms, definitions, and diagnostic criteria are needed among clinicians worldwide. Early recognition and diagnosis of adenomyosis and associated endometriosis are essential for streamlined treatment, improved quality of life, and prevention of disease progression.