Current Non-Invasive Imaging Techniques Used in the Diagnosis of Adenomyosis

Objective: This review aims to provide insights into the current non-invasive imaging methods used in the diagnosis of adenomyosis, as well as to highlight their diagnostic accuracy, advantages, disadvantages and limitations in the detection of this benign uterine condition. At the same time, this paper emphasizes the importance of using consensus-based terminology in the imaging description of these lesions. Mechanism: A search of PUBMED database was conducted for articles published between January 1998 and August 2022 and studies which compared non-invasive imaging methods with postoperative histology examination of uterine specimens were primarily selected. Transvaginal two-dimensional ultrasound was for a long time the main non-invasive imagistic method used for assessment of adenomyosis lesions. The introduction of Morphological Uterus Sonographic Assessment (MUSA) group criteria yielded a significantly better diagnostic outcome of adenomyosis in case of conventional ultrasonography, but the distinction of concomitant benign uterine conditions still remained challenging. Findings in Brief: The addition of three-dimensional ultrasound or elastosonography to conventional two-dimensional transvaginal ultrasound yielded higher diagnostic sensitivity. Qualitative elastography particularly proved useful in the diagnosis of adenomyosis due to its capacity to achieve differential diagnosis of benign uterine pathologies based on lesion stiffness. Magnetic resonance imaging (MRI) examination presents higher diagnostic specificity and sensitivity, can assess the endometrial and myometrial layers in detail, but its use has been shadowed by costs and significantly longer examination time. Conclusions: The imaging terminology established by consensus by the MUSA group in recent years has facilitated the description of adenomyosis-specific lesions. Two-dimensional transvaginal ultrasound in combination with three-dimensional ultrasound or combined with qualitative elastography offers similar diagnostic sensitivity and specificity to MRI. Despite some limitations, MRI remains a reliable diagnostic method for adenomyosis.