From Clinical Symptoms to MR Imaging: Diagnostic Steps in Adenomyosis

Table 1

Diagnostic methods and their typical findings in adenomyosis.

Diagnostic method	Findings	References
Clinical history and symptoms	Dysmenorrhea, abnormal bleedings, pelvic pain, dyspareunia	[1, 16–19]
Gynecological examination	Uterine and pelvic pain, uterine size and mobility, deep infiltrating endometriosis	[1, 12, 20]
2D transvaginal ultrasound	Heterogeneous myometrium, hyperechoic linear striation in the myometrium, myometrial anechoic cysts, subendometrial microcysts, asymmetrical myometrial thickening, globally uterine enlargement, question mark sign, thickening of the junctional zone, hyperechoic myometrial areas	[21–26]
3D transvaginal ultrasound	JZ (max) 8 mm, myometrial asymmetry, hypoechoic striation	[26–29]
MR imaging	JZ (max) 12 mm, high-signal-intensity myometrial spot, JZ (max) to myometrial thickness ratio 40%	[30–34]
Hysteroscopy	Irregular endometrium, endometrial defects, altered vascularization, cystic lesions	[22, 24, 35–37]
Laparoscopy	Uterine enlargement, pillowy resistance, “blue sign,” cystic subserous lesions	[22, 38–40]