Ultrasonography in the diagnosis of adenomyosis

an integrative review

Abstract

Adenomyosis presents a diagnostic challenge in gynecological practice due to its nonspecific
symptoms, such as dysmenorrhea and abnormal uterine bleeding, which overlap with various other
uterine pathologies. For many years, definitive diagnosis was only possible through hysterectomy,
limiting early detection and conservative treatment strategies. With advances in imaging techniques,
there is a growing need to evaluate non-invasive, effective, and accessible diagnostic tools.
This integrative review explores the role of ultrasonography—particularly transvaginal ultrasound
(TVUS)—as the primary screening and diagnostic modality for adenomyosis. TVUS demonstrates
good sensitivity and specificity, being capable of identifying features such as a heterogeneous
myometrium, myometrial cysts, hypoechoic striations, and alterations in the junctional zone (JZ).
The use of three-dimensional TVUS improves visualization of the JZ, although it does not significantly
enhance diagnostic accuracy compared to the two-dimensional mode.
The review also addresses the utility of color Doppler and elastography in differentiating
adenomyosis from leiomyomas, as well as the potential of contrast-enhanced ultrasound, which
remains under investigation. Despite its diagnostic efficacy, TVUS is operator-dependent, and in
inconclusive cases, magnetic resonance imaging (MRI) should be used as a complementary method.
In conclusion, this article emphasizes that ultrasonography, when properly performed, is a
fundamental diagnostic tool for the early detection of adenomyosis, enabling less invasive and
more personalized treatment approaches for patients.