Adenomyosis Diagnosis Guidelines

Diagnostic Performance and Imaging Recommendations

Transvaginal ultrasound using MUSA criteria demonstrates pooled sensitivity of 82.5% and specificity of 84.6% for adenomyosis diagnosis, according to the American College of Radiology 1
MRI can display the endometrium even when obscured by adenomyosis on ultrasound, and junctional zone thickening and T2 hyperintense foci are characteristic MRI findings, with 78-88% sensitivity and 67-93% specificity for adenomyosis, as reported by the Journal of the American College of Radiology 2
When ultrasound is inconclusive or adenomyosis obscures endometrial visualization, MRI should be considered, as recommended by Praxis Medical Insights 3, 1

In symptomatic patients, approximately 16% may not demonstrate any direct ultrasound signs despite having clinical adenomyosis, potentially creating false negatives with strict application of the diagnostic criteria, highlighting the need for clinical context integration with imaging findings 1
Clinical context must be integrated with imaging findings to avoid underdiagnosis, especially in symptomatic populations where other causes have been excluded, and adenomyosis remains highly probable even without direct signs 1

Standard pelvic ultrasound protocols do not routinely include the detailed assessment needed to identify adenomyosis features, unlike the expanded protocols developed for endometriosis mapping, according to the American College of Radiology 4

The American Society for Reproductive Medicine acknowledges that clinical context must be integrated with imaging findings to avoid underdiagnosis, especially in symptomatic populations where other causes have been excluded and adenomyosis remains highly probable, as noted in Human Reproduction Update 5