Magnetic resonance imaging in the diagnosis of adenomyosis

a narrative review

Abstract

Adenomyosis is a gynecological condition characterized by the ectopic presence of endometrial
tissue within the uterine myometrium, and it can present in either focal or diffuse forms. This
narrative review aims to evaluate the role of magnetic resonance imaging (MRI) in the diagnosis
and clinical management of adenomyosis. Studies published between 2005 and 2025 were
analyzed from databases including PubMed, Scopus, Google Scholar, and Lilacs, focusing on the
application of MRI in identifying adenomyosis. MRI stands out as a non-invasive imaging modality
with high sensitivity and specificity, surpassing transvaginal ultrasound (TVUS), particularly in
inconclusive cases. The main diagnostic feature is a thickened junctional zone (>12 mm), although
additional findings—such as small cysts, low-signal-intensity striations on T2-weighted images, and
hemorrhagic foci on T1—are also relevant. MRI allows for differentiation between disease subtypes,
including focal adenomyosis, diffuse adenomyosis, adenomyoma, and cystic adenomyosis, and
provides comprehensive evaluation of adjacent pelvic structures. It also assists in ruling out
differential diagnoses, such as leiomyomas and endometrial tumors. Despite its higher cost, MRI is
recommended as a second-line imaging modality according to the 2017 guidelines of the European
Society of Urogenital Radiology (ESUR), especially in the assessment of endometriosis and complex
pelvic pathologies. In conclusion, MRI is an essential tool for accurate diagnosis and therapeutic
planning in adenomyosis.