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Magnetic resonance imaging and transvaginal ultrasonography for the diagnosis of adenomyosis
Open accessAbstract
Objective To compare the diagnostic potential of magnetic resonance imaging (MRI) and transvaginal ultrasonography (TVS) in the diagnosis of adenomyosis.Design Double blind set-up.Setting University medical school.Patient(s) We studied 106 consecutive premenopausal women who underwent hysterectomy for benign reasons.Intervention(s) Transvaginal ultrasonography and MRI were compared with histopathologic examination as the golden standard.Main outcome measure(s) Adenomyosis.Result(s) Twenty-two (21%) patients had adenomyosis. The sensitivity and specificity were as follows: sensitivity: MRI 0.70 (0.46-0.87) and TVS 0.68 (0.44-0.86) (P=.66); specificity: MRI 0.86 (0.76-0.93) and TVS 0.65 (0.50-0.77) (P=.03). The combination of MRI and TVS was most sensitive (0.89 [0.64-0.98]), but produced the lowest specificity (0.60 [0.44-0.73]). Adenomyosis was not detected by either MRI or TVS at uterine volumes >400 mL. Exclusion of uteri >400 mL from the analysis improved the diagnostic precision of MRI, but not that of TVS. The diagnostic accuracy at MRI was improved by calculating the maximum difference between the thinnest and thickest junctional zone (JZdif) (i.e., > or =5-7 mm).Conclusion(s) Magnetic resonance imaging was superior to TVS for the diagnosis of adenomyosis. Magnetic resonance imaging had a higher specificity than TVS, but their sensitivities were in line. The diagnostic accuracy of MRI, as that of TVS, was at an intermediate level, but the diagnostic accuracy of the former improved by exclusion of uteri >400 mL. The combination of MRI and TVS produced the highest level of accuracy for exclusion of adenomyosis, but the low specificity may necessitate further investigation of positive findings. Measurement of the difference in junctional zone thickness may optimize the diagnosis of adenomyosis at MRI.
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“There is a significant association of pelvic endometriosis with uterine adenomyosis in women and in the baboon with life-long infertility.”
From The pathophysiology of endometriosis and adenomyosis, tissue injury and repair (2009) · cites this paper as [25]
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“Focal, not well-demarcated, high-intensity or low-intensity areas in the myometrium also correlate with adenomyosis (70).”
BackgroundDiagnosing adenomyosis: an integrated clinical and imaging approach
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“[91], the third one seems to be more independent from hormonal status being a difference of two measurements both taken in the same hormonal phase.”
BackgroundThe Impact of Adenomyosis on Women's Fertility
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“Adenomyosis is most often diagnosed in the presence of 3 or more sonographic criteria.(8,12) On 3D TVS, features linked to adenomyosis were JZmax 8 mm or greater, myometrial asymmetry, and hypoechoic striations.”
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“MRI seems to perform more favorably than TVUS in these situations (12,50).”
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“…the endometrial surface Women in wom adenomyosis was suspected on the basis of unexplained pelvic pain, menorrhagia and lack of evidence of leiomyoma on USG Dueholm et al. (2001) Prospective double-blinded study Histopathological examination The presence of focal areas with not well-defined…”
BackgroundMRI Characteristics of the Uterine Junctional Zone: From Normal to the Diagnosis of Adenomyosis
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Pathogenesis of Endometriosis: The Origin of Pain and Subfertility
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“In 3D ultrasounds, the border of the endometrium and myometrium becomes broader and illustrates the transgression of endometrium cells into the myometrium [14,15].”
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“In a study comparing TVUS andMRI for the diagnosis of adenomyosis, with hysterectomy and histopathologic evaluation, the referent technique, MRI, was shown to be more sensitive but equally specific [44].”
MethodTransvaginal ultrasound or MRI for diagnosis of adenomyosis
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The pathophysiology of uterine adenomyosis: an update
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Self-citationUterine adenomyosis: a need for uniform terminology and consensus classification
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“Co-existing uterine pathologies when the uterus is large or multiple myomas are found may render ultrasound diagnosis unreliable (Dueholm et al., 2001).”
BackgroundAdenomyosis and risk of preterm delivery
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“In our study, two experienced ultrasonographers used a standard set of diagnostic criteria [21] similar to that used with MRI.”
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“The plots for each individual study, as well as the combined results, are shown in Figure 3a and 3b [16-20, 22, 23, 28”
InfluentialA new concept of endometriosis and adenomyosis, tissue injury and repair (TIAR)
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“According to some authors, a junctional zone thickness between 8 and 12 mm can be diagnosed as adenomyosis, but requires ancillary criteria [22, 27].”
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“In all patients, the largest parameter, either anterior or posterior, was used to compare the JZmax measurement at baseline with the measurement obtained at the 6-month evaluation [10].”
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“These morphological features have been accepted with a wide consensus as reliable morphological markers of adenomyosis.(6-9,21-23)”
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“The relative weight of the different features in establishing a correct diagnosis remains unclear, but more than one criterion and often three criteria are needed for an image diagnosis of AD, and the uterus should always be searched for clear features of heterotopic endometrium (9,10).”
BackgroundMethodSelf-citationAdenomyosis and junctional zone changes in patients with endometriosis
Larsen, S. B., Lundorf, E., Forman, A., & Dueholm, M. (2011) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2011.03.003 · Cited by 110
Self-citationAdenomyosis as a disorder of the early and late human reproductive period
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Spectrum of MR features in adenomyosis
Tamai, K., Koyama, T., Umeoka, S., Saga, T., Fujii, S., & Togashi, K. (2006) · Best Practice & Research Clinical Obstetrics & Gynaecology · doi:10.1016/j.bpobgyn.2006.01.009 · Cited by 97
The uterine junctional zone: a 3-dimensional ultrasound study of patients with endometriosis
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“Reinhold et al(22) demonstrated that a JZ thickness that measures >12 mm is highly predictive of adenomyosis and that an increased thickness of the posterior JZ of the uterus on magnetic resonance imaging (MRI) that is correlated with invasion of the basal endometrium into the innermyometrium has been proposed for the…”
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Imaging for Uterine Myomas and Adenomyosis
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Adenomyosis: a life-cycle approach
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“, 1996) and six comparing transvaginal ultrasound (Bazot et al., 2001, 2002; Dueholm et al., 2001; Kepkep et al., 2007; Reinhold et al., 1996; Vercellini et al., 1998), fulfilled quality criteria.”
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“[11], MR imaging is superior to TVS for the diagnosis of adenomyosis, having equal sensitivity but a higher specificity (sensitivity: MR 0.”
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“Adenomyosis may be reliably detected by both TVUS and MRI without the need for histological examination of a biopsy specimen [15, 18].”
BackgroundPathogenesis of Human Adenomyosis: Current Understanding and Its Association with Infertility
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“With the advent of non-invasive diagnoses with MRI and TVUS, the role of adenomyosis in infertility and early pregnancy has been better recognized [173,174].”
Value of Magnetic Resonance Imaging in Diagnosis of Adenomyosis and Myomas of the Uterus
Stamatopoulos, C., Mikos, T., Grimbizis, G., Dimitriadis, A. S., Efstratiou, I., Stamatopoulos, P., & Tarlatzis, B. C. (2012) · Journal of Minimally Invasive Gynecology · doi:10.1016/j.jmig.2012.06.003 · Cited by 69
“Dueholm et al [24], 2001 106 Prospective 20.”
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Uterine junctional zone and adenomyosis: comparison of MRI , transvaginal ultrasound and histology
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“The diagnosis is classically made by histological analysis of the uterus after hysterectomy but with the development of the imaging tools now it is easily made by transvaginal ultrasound (TVUS) or magnetic resonance imaging (MRI) with good sensitivity and specificity.(3,4) As nowadays, women are more often delaying ma…”
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Treatment of symptomatic adenomyosis with the levonorgestrel‐releasing intrauterine system
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Clinical factors affecting endometrial receptiveness in oocyte donation cycles
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Tocci, A., Greco, E., & Ubaldi, F. M. (2008) · Reproductive BioMedicine Online · doi:10.1016/s1472-6483(10)60207-6 · Cited by 60
“In MRI, some authors report an unacceptably low sensitivity in the diagnosis of adenomyosis at around 31% (Dueholm et al., 2001; Moghadam et al., 2006), while others reported better accuracy (Mark et al.”
ResultDiagnostic Accuracy of Transvaginal Ultrasound and Magnetic Resonance Imaging for Adenomyosis
Liu, L., Li, W., Leonardi, M., Condous, G. S., Costa, F. D. S., Mol, B. W., & Wong, L. (2021) · Journal of Ultrasound in Medicine · doi:10.1002/jum.15635 · Cited by 65
“There were three studies that compared both TVUS and MRI in the same cohort of patients.(12,41,42)”
ResultAndersson, J. K., Khan, Z., Weaver, A. L., Vaughan, L. E., Gemzell‐Danielsson, K., & Stewart, E. A. (2019) · Acta Obstetricia Et Gynecologica Scandinavica · doi:10.1111/aogs.13632 · Cited by 55
Valentin, L. (2006) · Best Practice & Research Clinical Obstetrics & Gynaecology · doi:10.1016/j.bpobgyn.2006.06.001 · Cited by 52
Chronic Pelvic Pain: A Comprehensive Review
Juganavar, A., & Joshi, K. S. (2022) · Cureus · doi:10.7759/cureus.30691 · Cited by 51
“Most gynecologists prefer MRI investigation to ultrasound in diagnosing the disease, as MRI shows a hypo or anechoic area in the uterine wall [10].”
BackgroundMRI and Adenomyosis: What Can Radiologists Evaluate?
Celli, V., Dolciami, M., Ninkova, R. V., Ercolani, G., Rizzo, S., Porpora, M. G., Catalano, C., & Manganaro, L. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19105840 · Cited by 49
“A second parameter is the “JZ differential” (JZdiff), defined as the differential in maximal and minimal JZ thickness in both anterior and posterior uterine walls; the literature reports that a JZdiff > 5 mm has a sensitivity and a specificity of 70% and 85%, respectively [16].”
BackgroundResultDevelopment of a clinical prediction model for diagnosing adenomyosis
Tellum, T., Nygaard, S., Skovholt, E. K., Qvigstad, E., & Lieng, M. (2018) · Fertility and Sterility · doi:10.1016/j.fertnstert.2018.06.009 · Cited by 49
Alcázar, J. L., Vara, J., Usandizaga, C., AJOSSA, S., Pascual, M. A., & Guerriero, S. (2022) · International Journal of Gynecology & Obstetrics · doi:10.1002/ijgo.14609 · Cited by 52
Classification of menstrual bleeding disorders
Munro, M. G. (2012) · Reviews in Endocrine and Metabolic Disorders · doi:10.1007/s11154-012-9220-x · Cited by 46
“While there is evidence that establishing a threshold number of three of these criteria for making a diagnosis [28], the ideal number has not been established.”
BackgroundAdenomyosis: What the Patient Needs
Alabiso, G., ALIO, L., Arena, S., di Prun, A. B., Bergamini, V., Berlanda, N., Busacca, M., Candiani, M., Centini, G., Cello, A. D., et al. (2016) · Journal of Minimally Invasive Gynecology · doi:10.1016/j.jmig.2015.12.017 · Cited by 43
Predictive value of magnetic resonance imaging in differentiating between leiomyoma and adenomyosis.
Moghadam, R., Lathi, R. B., Shahmohamady, B., Saberi, N. S., Nezhat, C., Nezhat, F. R., & NEZHAT, C. R. (2006) · PubMed Central · Cited by 43
The Asian Society of Endometriosis and Adenomyosis guidelines for managing adenomyosis
Harada, T., Taniguchi, F., Guo, S., Choi, Y. M., Biberoglu, K. O., Tsai, S. S., Alborzi, S., Al‐Jefout, M., Chalermchockcharoenkit, A., Sison-Aguilar, A. G., et al. (2023) · Reproductive Medicine and Biology · doi:10.1002/rmb2.12535 · Cited by 44
“14 Other studies reported no difference in pregnancy outcomes or miscarriage rate.”
BackgroundInfluentialYamanaka, A., Kimura, F., Yoshida, T., Kita, N., Takahashi, K., Kushima, R., & Murakmai, T. (2016) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2016.07.499 · Cited by 42
“Adenomyosis was diagnosed by the presence of either diffuse or focal thickening of the inner myometrium or an ill-defined myometrial nodule of low signal intensity on T2-weighted magnetic resonance imaging (MRI) [14,15].”
BackgroundQuestion Mark Sign and Transvaginal Ultrasound Uterine Tenderness for the Diagnosis of Adenomyosis
Zannoni, L., Ambrosio, M., Raimondo, D., Arena, A., Forno, S. D., Borghese, G., Paradisi, R., & Seracchioli, R. (2020) · Journal of Ultrasound in Medicine · doi:10.1002/jum.15237 · Cited by 42
Froeling, V., Scheurig‐Muenkler, C., Hamm, B., & Kröncke, T. J. (2011) · CardioVascular and Interventional Radiology · doi:10.1007/s00270-011-0254-3 · Cited by 42
Elastosonography: a possible new tool for diagnosis of adenomyosis?
Tessarolo, M., Bonino, L., Camanni, M., & Deltetto, F. (2011) · European Radiology · doi:10.1007/s00330-011-2064-z · Cited by 41
“Transvaginal ultrasound (TVU) and magnetic resonance (MR) are currently the two imaging techniques most commonly used in the diagnosis of adenomyosis [2, 5 ]. TVU, in particular, is widely available, relatively inexpensive, non-invasive and well tolerated by women, thus making it the first-line examination for gynaeco…”
MethodRasmussen, C. K., Hansen, E. S., Ernst, E., & Dueholm, M. (2018) · Reproductive BioMedicine Online · doi:10.1016/j.rbmo.2018.12.033 · Cited by 41
Self-citationAdenomyosis:Common and Uncommon Manifestations on Sonography and Magnetic Resonance Imaging
Chopra, S., Lev-Toaff, A. S., Örs, F., & Bergin, D. (2006) · Journal of Ultrasound in Medicine · doi:10.7863/jum.2006.25.5.617 · Cited by 40
Nam, J. (2019) · Journal of obstetrics and gynaecology research · doi:10.1111/jog.14145 · Cited by 39
“This condition can be diagnosed using ultrasonography and magnetic resonance imaging.(2) A definitive diagnosis of adenomyosis can be made by histological examination of a hysterectomy specimen and by transvaginal core needle biopsy.”
BackgroundRees, C. O., Nederend, J., Mischi, M., van Vliet, H. A. A. M., & Schoot, B. C. (2021) · Acta Obstetricia Et Gynecologica Scandinavica · doi:10.1111/aogs.14139 · Cited by 42
Adenomyosis: An Update Concerning Diagnosis, Treatment, and Fertility
Selntigia, A., Molinaro, P., Tartaglia, S., Pellicer, A., Galliano, D., & Cozzolino, M. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13175224 · Cited by 43
Adenomyosis and Adolescence: A Challenging Diagnosis and Complex Management
Martire, F. G., d’Abate, C., Schettini, G., Cimino, G., Ginetti, A., Colombi, I., Cannoni, A., Centini, G., Zupi, E., & Lazzeri, L. (2024) · Diagnostics · doi:10.3390/diagnostics14212344 · Cited by 38
“Although the diagnosis of adenomyosis primarily relies on JZ features in MRI, both direct and indirect signs within the myometrium can also be assessed [52–60].”
BackgroundMRI appearances of benign uterine disease
Sudderuddin, S. A., Helbren, E., Telesca, M., Williamson, R. C. N., & Rockall, A. (2014) · Clinical Radiology · doi:10.1016/j.crad.2014.05.108 · Cited by 38
Optimal management of chronic cyclical pelvic pain: an evidence-based and pragmatic approach
Abbott, J. (2010) · International Journal of Women s Health · doi:10.2147/ijwh.s7991 · Cited by 38
Rasmussen, C. K., Hansen, E. S., & Dueholm, M. (2018) · Journal of Ultrasound in Medicine · doi:10.1002/jum.14735 · Cited by 36
“experienced gynecologist with several years of experience in the US diagnosis of adenomyosis.(6,13,14,16,22) In collaboration, the raters created standardized protocols for diagnosing adenomyosis by real-time 2D TVUS and offline 3D TVUS based on characteristic US features.”
BackgroundSelf-citationDueholm, M., & Hjorth, I. M. D. (2016) · Best Practice & Research Clinical Obstetrics & Gynaecology · doi:10.1016/j.bpobgyn.2016.09.010 · Cited by 34
Self-citationStoelinga, B., Hehenkamp, W. J. K., Nieuwenhuis, L. L., Conijn, M. M. A., van Waesberghe, J. T. M., Brölmann, H. A. M., & Huirne, J. A. F. (2018) · Ultrasound in Medicine & Biology · doi:10.1016/j.ultrasmedbio.2018.03.027 · Cited by 36
ACR Appropriateness Criteria® on Abnormal Vaginal Bleeding
Bennett, G. L., Andreotti, R. F., Lee, S. I., Allison, S. O. D., Brown, D. L., Dubinsky, T. J., Glanc, P., Mitchell, D. G., Podrasky, A. E., SHIPP, T. D., et al. (2011) · Journal of the American College of Radiology · doi:10.1016/j.jacr.2011.03.011 · Cited by 34
Zacharia, T. T., & O'Neill, M. J. (2006) · British Journal of Radiology · doi:10.1259/bjr/70121266 · Cited by 33
“Some investigations performed recently have shown MRI to have very high sensitivity and specificity in the diagnosis of adenomyosis [3, 4].”
BackgroundXue, J., Zhang, H., Liu, W. Y., Liu, M., Shi, M., Wen, Z., & Li, C. (2013) · Reproduction · doi:10.1530/rep-13-0135 · Cited by 31
How to Evaluate Adenomyosis in Patients Affected by Endometriosis?
Donato, N. D., & Seracchioli, R. (2014) · Minimally Invasive Surgery · doi:10.1155/2014/507230 · Cited by 32
“However, recently transvaginal ultrasound has reached a high level of accuracy and many authors have reported the high agreement between ultrasound diagnosis of adenomyosis and histological findings [17, 47].”
BackgroundSonohysterography: Principles, technique and role in diagnosis of endometrial pathology
Yang, T. W. (2013) · World Journal of Radiology · doi:10.4329/wjr.v5.i3.81 · Cited by 29
Morelli, M., Rocca, M. L., Venturella, R., Mocciaro, R., & Zullo, F. (2013) · Gynecological Endocrinology · doi:10.3109/09513590.2012.743017 · Cited by 29
“These issues are partly overcome by the use of trans-vaginal ultrasound scanning (TV-US), which reaches a sensitivity of 65% and specificity of 65–80% to diagnose adenomyosis [13,14] but it is less helpful in diagnosing small endometriosic pelvic lesions.”
BackgroundMetin, M. R., Aydın, H., Ünal, Ö., Akçay, Y., Duymuş, M. E., Türkyılmaz, E., & Avcu, S. (2015) · Diagnostic and Interventional Imaging · doi:10.1016/j.diii.2015.11.007 · Cited by 29
“[6] Dueholm M, Lundorf E, Hansen ES, Sorensen JS, Ledertoug S, Olesen F.”
Background
Metadata
- Authors
- Dueholm, M., Lundorf, E., Hansen, E. S., Sørensen, J. S., Ledertoug, S., & Olesen, F.
- Affiliations
- Aarhus University (DK)
- Corresponding author
- Dueholm, Margit
- Venue
- Fertility and Sterility
- Publisher
- Elsevier BV
- Published
- 2001-09
- Volume
- 76
- Issue
- 3
- Pages
- 588-594
- ISSN
- 0015-0282 (ISSN-L)
- OpenAlex
- W1966951938
- Cited by
- 273
- References
- 25
- Citations by year
- 2026: 7 · 2025: 9 · 2024: 10 · 2023: 13 · 2022: 15 · 2021: 16 · 2020: 13 · 2019: 22 · 2018: 10 · 2017: 10 · 2016: 13 · 2015: 15 · 2014: 15 · 2013: 9 · 2012: 12
- FWCI
- 3.22
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Fertility and Sterility (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
- Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
- Keywords
- adenomyosis, magnetic resonance imaging, transvaginal ultrasound, diagnostic accuracy, sensitivity and specificity, uterine volume, premenopausal women, hysterectomy, histopathological diagnosis
- MeSH terms
- Adult, Double-Blind Method, Endometriosis, Female, Humans, Hysterectomy, Magnetic Resonance Imaging, Middle Aged, Myometrium, Sensitivity and Specificity, Ultrasonography, Vagina, Reproducibility of Results, Observer Variation, Premenopause
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