Purpose of review: Transvaginal ultrasound and MRI are used to diagnose adenomyosis. This review summarizes the current evidence on the diagnostic accuracy of these techniques.
Recent findings: The image resolution of both transvaginal ultrasound and MRI is effective for the diagnosis of adenomyosis. In a limited number of well-designed studies the diagnostic efficiency of MRI and transvaginal ultrasound were almost in line. With transvaginal ultrasound, considerable training is needed to recognize the distinct ultrasound pattern in the diagnosis of adenomyosis. The findings in MRI are less observer dependent, but still somewhat dependent on an MRI observer who is expert in gynecologic imaging.
Summary: Transvaginal ultrasound is the natural first choice of image modality when investigating pelvic pain or menstrual disorders, but correct diagnosis of adenomyosis is dependent on sonographers trained in pattern recognition of adenomyosis. When transvaginal ultrasound provides indefinite findings or when dealing with difficult cases with coexistence of other abnormalities (myomas and severe endometriosis), MRI may add information and increase the diagnostic performance.