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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.”
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“Currently, no guidelines directing the management of adenomyosis are available, despite numerous treatments, both medical and surgical in nature [28,29].”
BackgroundMRI of Adenomyosis: Where Are We Today?
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“However, other studies have shown higher rates compared to these figures in the TVS diagnosis of adenomyosis (70–93% sensitivity and specificity and 21–33% adenomyosis prevalence rate) [5, 60, 61].”
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“Adenomyosis was once considered a disease of multiparous women in late reproductive age, usually diagnosed after hysterectomies (1).”
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Ultrasound Imaging in Endometriosis
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“Third, for patients receiving conservative therapy, the evolution of the disease may be monitored with imaging (Dueholm et al. 2001).”
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Sonographic Signs of Adenomyosis in Women with Endometriosis Are Associated with Infertility
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“These findings were chosen because they are recognized, reliable morphological sonographic markers for adenomyosis [19,20,23,24] and can be differentially diagnosed from fibroids [24].”
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“MRI of the uterus represents the best means in vivo of documenting the diVerent layers of the uterine wall, and particularly of the JZ myometrium and its alterations like adenomyosis [1–9].”
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“La visualisation de petits spots hyperintenses juxta-endométriaux au sein de l’hyposignal en pondération T1 ou surtout T2 conforte le diagnostic avec une spécificité proche de 100 % mais malheureusement une sensibilité proche de 50 % [23, 24, 60].”
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InfluentialMagnetic Resonance Imaging in endometriosis-associated pain
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“Ein wichtiger Vorteil der Magnetresonanztomographie ist die hohe Sensitivität und Spezifität,mit der die wichtige Differenzialdiagnose einer Adenomyosis uteri detektiert werden kann und die in der Literatur mit 70 und 86% angegeben wird [7].”
BackgroundUterine artery embolisation for symptomatic fibroids in a tertiary hospital in Singapore.
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The accuracy of transvaginal ultrasound and uterine artery Doppler in the prediction of adenomyosis
ElKattan, E. A., Omran, E., & Inany, H. G. A. (2010) · Middle East Fertility Society Journal · doi:10.1016/j.mefs.2010.04.003 · Cited by 6
Siegelman, E. S. (2005) · Elsevier eBooks · doi:10.1016/b978-0-7216-3740-2.50012-1 · Cited by 6
Gynecological associated disorders and management
Jia, X., Rana, N., Crouss, T. M., & WHITMORE, K. E. (2019) · International Journal of Urology · doi:10.1111/iju.13974 · Cited by 6
Adenomyosis and coexisting gynecologic pathologies: How often do they coexist?
Çelik, H. G., Erkan, İ. B. Ö., Topçu, E. G., Sözen, I., Gündüz, N., Saricoban, C. T., İlvan, Ş., Demirkıran, F., & Oral, E. (2025) · International Journal of Gynecology & Obstetrics · doi:10.1002/ijgo.70261 · Cited by 5
“2,14 17 According to literature, adenomy-osis is identified in 20%–25% of hysterectomy specimens.”
Characterization of patients that can continue conservative treatment for adenomyosis
Miyagawa, C., Murakami, K., Tobiume, T., Nonogaki, T., & Matsumura, N. (2021) · BMC Women s Health · doi:10.1186/s12905-021-01577-x · Cited by 6
“The criteria for diagnosis by MRI were the presence of an enlarged myometrium with an indistinct limbus and a heterogeneous internal signal on T2-weighted images or thickening of the junctional zone (> 12 mm) [15, 16].”
BackgroundThe Pathophysiology of Adenomyosis
Habiba, M. A., Benagiano, G., & Brosens, I. A. (2015) · Springer eBooks · doi:10.1007/978-3-319-13012-5_3 · Cited by 5
Adenomyosis and Ultrasound: The Role of Ultrasound and Its Impact on Understanding the Disease
Exacoustós, C. (2015) · Springer eBooks · doi:10.1007/978-3-319-13012-5_9 · Cited by 5
THE ROLE OF MAGNETIC RESONANCE IMAGING IN THE EVALUATION OF GYNECOLOGIC DISEASE
Westphalen, A. C., & Qayyum, A. (2008) · Elsevier eBooks · doi:10.1016/b978-1-4160-3264-9.50037-9 · Cited by 5
Khan, K. N. (2024) · Journal of physiological investigation. · doi:10.4103/ejpi.ejpi-d-24-00032 · Cited by 4
Myometrial wall thickness ratio—A nomogram reference for diagnosing myometrial wall asymmetry
Garcia, D., Ivañez-Muñoz, M., Salazar, B., Ramirez, B., Olaso, F., & Alcázar, J. L. (2022) · Journal of Clinical Ultrasound · doi:10.1002/jcu.23189 · Cited by 4
“ultrasound as the first choice imaging technique for the assessment of adenomyosis.(4) On the 2015, the group Morphological Uterus Sonographic Assessment (MUSA) proposed a consensus for the description of the myometrial pathology, including the definition the ultrasound findings associated to adenomyosis.”
MethodThe role of MRI in the diagnosis of endometriosis
Ibrahim, N. M. A., & Elsaeed, H. H. (2012) · The Egyptian Journal of Radiology and Nuclear Medicine · doi:10.1016/j.ejrnm.2012.09.005 · Cited by 4
Medema, A. M., Zanolli, N. C., Cline, B. C., Pabon‐Ramos, W. M., & Martin, J. G. (2024) · Current Problems in Diagnostic Radiology · doi:10.1067/j.cpradiol.2024.01.028 · Cited by 4
The Incidence and Clinical Significance of Adenomyosis
Habiba, M. A., & Benagiano, G. (2015) · Springer eBooks · doi:10.1007/978-3-319-13012-5_2 · Cited by 4
Endokrine operative Therapie der Adenomyosis
Keckstein, J., & Ulrich, U. A. (2004) · Gynäkologische Endokrinologie · doi:10.1007/s10304-004-0049-6 · Cited by 4
A Case of Adenomyosis per se with a Uterine Weight of 475 g
Harmanli, Ö. H., Shen, T., Zhu, S., & Chatwani, A. J. (2004) · Gynecologic and Obstetric Investigation · doi:10.1159/000080360 · Cited by 4
Uterine Peristalsis and the Development of Endometriosis and Adenomyosis
LEYENDECKER, G., & Wildt, L. (2011) · Wiley eBooks · doi:10.1002/9781444398519.ch20 · Cited by 4
Perspectives in transvaginal sonography for the diagnosis of adenomyosis
An, X.-L., Zhang, J., Yun, X.-C., Lei, X.-H., Zhao, J., Yang, X.-H., & Liu, M. (2025) · Frontiers in Medicine · doi:10.3389/fmed.2025.1533648 · Cited by 3
An unexpected diagnosis of adenomyosis in the subfertile woman
Hunjan, T., & Davidson, A. (2015) · BMJ Case Reports · doi:10.1136/bcr-2014-209012 · Cited by 3
Imaging diagnosis of adenomyosis
Balogun, M. (2005) · Reviews in Gynaecological and Perinatal Practice · doi:10.1016/j.rigp.2005.09.004 · Cited by 3
“in their study suggested that the diagnostic accuracy at MRI could be improved by calculating the maximum difference between the thinnest and thickest portions of the junctional zone with a value of 5–7 mm [18].”
BackgroundResultBildgebende Diagnostik vor und nach Uterusmyomembolisation
Kröncke, T. J. (2008) · Der Radiologe · doi:10.1007/s00117-008-1686-x · Cited by 3
Adenomyosis and Its Effect on Reproductive Outcomes
Henderson, I. (2014) · Journal of Women s Health Care · doi:10.4172/2167-0420.1000207 · Cited by 3
“T2-weighted MRI Large, regular, asymmetric uterus Maximal junctional zone ≥ 12mm and/or ill-defined low signal area [16,25,26] Ratiomax 2>40% [16] JZdif>5mm [27] High-intensity myometrial foci [16,25-27]”
BackgroundInfluentialUltrasound assessment of uterine morphology in menorrhagia: case control study
Ting, S. O., & Burke, C. (2019) · Journal of Obstetrics and Gynaecology · doi:10.1080/01443615.2019.1622084 · Cited by 3
“…George and Bourne (2003) both stated that about 30% of women describe heavy menstruation; however, subjective assessment of menstrual blood loss according to studies performed by Sheil and Turner (1996) and Deuholm et al. (2001) does not always correlate with clinically-measured blood loss volumes.”
ResultObesity and chronic pelvic pain
Tan, I.-F., & Horne, A. W. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-817919-2.00031-0 · Cited by 3
Obstetric and neonatal outcomes in women with internal and non-internal adenomyosis
Qi, Y., Zhang, Y., Zhuang, L., Liu, J., Zeng, X., Liu, D., Zhu, T., & Huang, Y. (2026) · Reproductive BioMedicine Online · doi:10.1016/j.rbmo.2026.105501 · Cited by 2
MRI of Adenomyosis: Where Are We Today?
Zhang, M., Bazot, M., Tsatoumas, M., Munro, M. G., & Reinhold, C. (2022) · Current Obstetrics and Gynecology Reports · doi:10.1007/s13669-022-00342-7 · Cited by 2
“MRI is the preferred imaging modality when there are concomitant pathologies such as endometriosis and particularly leiomyomas.(18,21,22) In fact, adenomyosis cannot be accurately diagnosed by TVUS in the presence of more than 3 leiomyomas or an enlarged uterus of more than 300 cc in volume.”
BackgroundCONTROVERSIAL ISSUES OF RADIOLOGIC DIAGNOSIS OF ADENOMYOSIS IN REPRODUCTIVE LOSSES
Pomortsev, A. V., Grushevskaya, Y. V., & Makukhina, T. B. (2019) · Кубанский научный медицинский вестник · doi:10.25207/1608-6228-2019-26-2-173-190 · Cited by 2
Endometriosis and adenomyosis – a shared pathophysiology
LEYENDECKER, G., Wildt, L., & Mall, G. (2010) · CNR Solar (Scientific Open-access Literature Archive and Repository) (Consiglio Nazionale delle Ricerche) · Cited by 2
Adenomyosis: Pathologies associated in a set of patients underwent hysterectomy
Sordia-Hernández, L. H., Herrero, J., Martinez, A. M., Gris, J. M., Rodríguez, D. S., Gutiérrez, Ó. V., & Castro, C. (2012) · Asian Pacific Journal of Reproduction · doi:10.1016/s2305-0500(13)60093-7 · Cited by 2
Adenomiosis: una afección uterina frecuente
Gallo, J. L., Herrezuelo, I. P., Díaz, M. A., Tirado, P., & Montoya, F. (2006) · Clínica e Investigación en Ginecología y Obstetricia · doi:10.1016/s0210-573x(06)74085-0 · Cited by 2
Imaging Modalities in Gynecology
Busse, R. M. (2010) · Donald School Journal of Ultrasound in Obstetrics & Gynecology · doi:10.5005/jp-journals-10009-1123 · Cited by 2
LEYENDECKER, G., & Wildt, L. (2011) · Springer eBooks · doi:10.1007/978-3-642-15012-8_9 · Cited by 2
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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