Adenomyosis: Transvaginal Ultrasound and Imaging Innovations for Diagnosis

Purpose of ReviewThere have been considerable advances in recent years using transvaginal sonography (TVUS) to diagnose adenomyosis. The diagnosis, however, is highly dependent upon the recognition of specific sonographic features as defined by the Morphological Uterus Sonographic Assessment (MUSA) statement. The main goal of this article is to review the literature in the last 5 years on specific TVUS features and imaging innovations for its diagnosis. We also sought to identify studies that evaluated the association between imaging-diagnosed adenomyosis and other clinical conditions.Recent FindingsDirect and indirect imaging signs of adenomyosis have been characterized for diagnosis. Although sonographic features and signs such as junctional zone >= 8 mm, question mark sign, fan-shaped striations, uterine biometric parameters, and uterine tenderness during the exam have been evaluated for diagnostic accuracy, no conclusions as yet can be made regarding the best TVUS imaging feature or a combination thereof for its diagnosis. Adenomyosis as suggested by TVUS findings is highly associated in patients with endometriosis and infertility. In particular, findings of external adenomyosis compared to internal adenomyosis are strongly correlated to patients with deep endometriosis. Studies suggest that scoring systems utilizing multiple sonographic observations or sonographic observations combined with patient clinical factors may improve accuracy. Imaging innovations using sonoelastography and contrast-enhanced ultrasound hold promise, notably in differentiating adenomyoma from leiomyoma.The accuracy of various TVUS imaging features and technologies has recently been evaluated for the diagnosis of adenomyosis. Improved recognition and reporting of these patterns will be key to confirming and clarifying the associations of adenomyosis to other conditions such as endometriosis and infertility that may direct clinical management and treatment.