Criteria

Morphological Uterus Sonographic Assessment (MUSA) features of adenomyosis[61][62]

The definitive diagnosis of adenomyosis relies on histopathologic examination, but recent interest has shifted toward using transvaginal ultrasound (TVUS) or magnetic resonance imaging (MRI) to make an imaging-supported diagnosis.

The TVUS diagnostic criteria proposed by the MUSA group are now internationally accepted. The MUSA criteria are based on eight features of adenomyosis that can be detected using two-dimensional (2D) TVUS, supplemented by three-dimensional (3D) TVUS to enhance the identification and evaluation of the junctional zone.[61] The criteria were subsequently divided into direct and indirect features of adenomyosis.[62] The direct features of adenomyosis are: the presence of cysts within the myometrium; hyperechogenic islands; and echogenic subendometrial lines or buds, which indicate the existence of ectopic endometrial glands and stroma beyond the subendometrial layer.[62] The indirect features are: a globular uterus; asymmetrical myometrial thickening; fan-shaped shadowing; translesional vascularity; an irregular or interrupted junctional zone.[62]

It is important to note that in the absence of direct features, the presence of indirect features alone is not conclusive evidence for the presence of adenomyosis.[62]

Use of this content is subject to our disclaimer