{"paper_id":"0025ff28-4d2e-4c8d-a819-f6a922195bec","body_text":"Abstract\nAdenomyosis is a common gynecologic disease characterized by the invasion of endometrial glands and stroma into the myometrium and is associated with smooth muscle hyperplasia and fibrosis. There are typical 2D sonographic features that are correlated to adenomyosis; some are more specific signs, like intramyometrial cystic and hyperechoic areas and the junctional zone (JZ) bud and lines. It is possible to visualize more clearly the JZ with some post-processing using coronal section of the uterus obtained with 3D TVS acquiring a higher diagnostic accuracy.\nIn the presence of these 2D and 3D TVS features for adenomyosis, the disease showed high anatomical-histological correlation. As histology, TVS findings are able to identify different types, infiltration depth, locations, and sizes of the disease. The types of adenomyosis can be defined as diffuse, focal, and adenomyoma according to the TVS characteristics. Adenomyosis may involve one or more of the uterine layers. The depth of myometrial infiltration is also variable, from cases limited to the more inner myometrium to those involving the whole myometrial thickness. Diffuse and focal adenomyosis therefore can be subsequently divided for the outer myometrium and for the inner myometrium or JZ. There are different attempts to describe by TVS the extension and the severity of the disease inside the uterus based on a number of features, on the percentage of the affected myometrium compared to the whole uterus, and on a TVS classification with score system that assesses the extension of each type of adenomyotic lesion (diffuse, focal, adenomyoma) in the external myometrium and in the JZ and is divided into four grades according to different measurements. The TVS assessment of type and extension of the disease may be helpful in selecting and evaluating the effectiveness of medical and surgical management, as well as the possible relationship between type and extension of adenomyosis and symptoms.\nAccess this chapter\nTax calculation will be finalised at checkout\nPurchases are for personal use only\nSimilar content being viewed by others\nReferences\nBazot M, Cortez A, Darai E, Rouger J, Chopier J, Antoine JM, Uzan S. Ultrasonography compared with magnetic resonance imaging for the diagnosis of adenomyosis: correlation with histopathology. Hum Reprod. 2001;16:2427–33.\nBazot M, Darai E, Rouger J, Detchev R, Cortez A, Uzan S. Limitations of transvaginal sonography for the diagnosis of adenomyosis, with histopathological correlation. Ultrasound Obstet Gynecol. 2002;20:605–11.\nBenagiano G, Brosens I. History of adenomyosis. Best Pract Res Clin Obstet Gynaecol. 2006;20:449–63.\nBenagiano G, Habiba M, Brosens I. The pathophysiology of uterine adenomyosis: an update. Fertil Steril. 2012;98:572–9.\nBird CC, McElin TW, Manalo-Estrella P. The elusive adenomyosis of the uterus – revisited. Am J Obstet Gynecol. 1972;112:583–93.\nBromley B, Shipp TD, Benacerraf B. Adenomyosis: sonographic findings and diagnostic accuracy. J Ultrasound Med. 2000;19:529–34.\nBrosens I, Derwig I, Brosens J, Fusi L, Benagiano G, Pijnenborg R. The enigmatic uterine junctional zone: the missing link between reproductive disorders and major obstetrical disorders? Hum Reprod. 2010;3:569–74.\nChampaneria R, Abedin P, Daniels J, Balogun M, Khan KS. Ultrasound scan and magnetic resonance imaging for the diagnosis of adenomyosis: systematic review comparing test accuracy. Acta Obstet Gynecol Scand. 2010;89:1374–84.\nChapron C, S Vannuccini, Santulli P, Abrao MS, Carmona F, Fraser IS, Gordts S, Guo SW, Just PA, Noel JC Pistofidis G , Van den Bosch T and Petraglia F. Diagnosis of adenomyosis: an integrated clinical and imaging approach Hum Reprod Update 2020;26:392–411.\nDi Donato N, Bertoldo V, Montanari G, Zannoni L, Caprara G, Seracchioli R. Question mark form of the uterus: a simple sonographic sign associated to the presence of adenomyosis. Ultrasound Obstet Gynecol. 2015;46:126–7.\nDi Donato N, Montanari G, Benfenati A, Leonardi D, Bertoldo V, Monti G, Raimondo D, Seracchioli R. Prevalence of adenomyosis in women undergoing surgery for endometriosis. Eur J Obstet Gynecol Reprod Biol. 2014;181:289–93.\nDueholm M, Lundorf E, Hansen ES, Ledertoug S, Sorensen JS, Olesen F. Magnetic resonance imaging and transvaginal ultrasonography for diagnosis of adenomyosis. Fertil Steril. 2001;76:588–94.\nDueholm M, Lundorf E. Transvaginal ultrasound or MRI for diagnosis of adenomyosis. Curr Opin Obstet Gynecol. 2007;19:505–12.\nExacoustos C, Brienza L, Di Giovanni A, Szabolcs B, Romanini ME, Zupi E, Arduini D. Adenomyosis: three-dimensional sonographic findings of the junctional zone and correlation with histology. Ultrasound Obstet Gynecol. 2011;37:471–9.\nExacoustos C, Luciano D, Corbett B, De Felice G, Di Feliciantonio M, Luciano A, Zupi E. The uterine junctional zone: a 3-dimensional ultrasound study of patients with endometriosis. Am J Obstet Gynecol. 2013;209:248–55.\nExacoustos C, Morosetti G, Conway F, Camilli S, Martire FG, Lazzeri L, Piccione E, Zupi E. New sonographic classification of adenomyosis: do type and degree of adenomyosis correlate to severity of symptoms? J Minim Invasive Gynecol. 2020;27:1308–15.\nHabiba M, Gordts S, Bazot M, Brosens I, Benagiano G. Exploring the challenges for a new classification of adenomyosis. Reprod Biomed Online. 2020;40:569–81.\nHarmsen M, Van den Bosch T, de Leeuw A, Dueholm M, Exacoustos C, Valentin L, Hehenkamp W, Groenman F, de Bruyn C, Rasmussen C, Lazzeri L, Jokubkiene L Jurkovic D, Naftalin J, Tellum T, Bourne T, Timmerman D, Huirne JAF Applicability of Morphological Uterus Sonographic Assessment (MUSA) features associated with adenomyosis among experts and refinements of definitions. Ultrasound Obstet Gynecol. 2021; in press.\nKepkep K, Tuncay YA, Goynumer G, Tutal E. Transvaginal sonography in the diagnosis of adenomyosis: which findings are most accurate? Ultrasound Gynecol Obstet. 2007;30:341–5.\nKunz G, Beil D, Huppert P, Noe M, Kissler S, Leyendecker G. Adenomyosis in endometriosis- prevalence and impact on fertility. Evidence from magnetic resonance imaging. Hum Reprod. 2005;20:2309–16.\nLarsen SB, Lundorf E, Forman A, Dueholm M. Adenomyosis and junctional zone changes in patients with endometriosis. Eur J Obstet Gynecol Reprod Biol. 2011;157:206–11.\nLazzeri L, Di Giovanni A, Exacoustos C, Tosti C, Pinzauti S, Malzoni M, Petraglia F, Zupi E. Preoperative and postoperative clinical and transvaginal ultrasound findings of adenomyosis in patients with deep infiltrating endometriosis. Reprod Sci. 2014;21:1027–33.\nLazzeri L, Morosetti G, Centini G, Monti G, Zupi E, Piccione E, Exacoustos C. A sonographic classification of adenomyosis: interobserver reproducibility in the evaluation of type and degree of the myometrial involvement. Fertil Steril. 2018;110:1154–61.\nLeyendecker G, Wildt L, Mall G. The pathophysiology of endometriosis and adenomyosis: tissue injury and repair. Arch Gynecol Obstet. 2009;280:529–38.\nLiu L, Wong L, Mol B, Condous G, Costa F, Leonardi M. Diagnostic accuracy of transvaginal ultrasound and magnetic resonance imaging for the diagnosis of adenomyosis: systematic review and meta-analysis. Ultrasound Med Biol. 2019;45:S54.\nLuciano DE, Exacoustos C, Albrecht L, Lamonica R, Proffer A, Zupi E, Luciano AA. Three-dimensional ultrasound in diagnosis of adenomyosis: histologic correlation with ultrasound targeted biopsies of the uterus. J Minim Invasive Gynecol. 2013;20:803–10.\nMartire FG, Lazzeri L, Conway F, Siciliano T, Pietropolli A, Piccione E, Solima E, Centini G, Zupi E, Exacoustos C. Adolescence and endometriosis: symptoms, ultrasound signs and early diagnosis. Fertil Steril. 2020;114:1049–57.\nMaruyama S, Imanaka S, Nagayasu M, Kimura M, Kobayashi H. Relationship between adenomyosis and endometriosis; different phenotypes of a single disease? Eur J Obstet Gynecol Reprod Biol. 2020;253:191–7.\nMeredith SM, Sanchez-Ramos L, Kaunitz AM. Diagnostic accuracy of transvaginal sonography for the diagnosis of adenomyosis: systematic review and meta analysis. Am J Obstet Gynecol. 2009;201:107.e1–107.\nNaftalin J, Hoo W, Nunes N, Holland T, Mavrelos D, Jurkovic D. Association between ultrasound features of adenomyosis and severity of menstrual pain. Ultrasound Obstet Gynecol. 2016;47:779–8308.\nNaftalin J, Hoo W, Nunes N, Mavrelos D, Nicks H, Jurkovic D. Inter- and intraobserver variability in three-dimensional ultrasound assessment of the endometrial-myometrial junction and factors affecting its visualization. Ultrasound Obstet Gynecol. 2012;39:587–91.\nNaftalin J, Hoo W, Pateman K, Mavrelos D, Holland T, Jurkovic D. How common is adenomyosis? A prospective study of prevalence using transvaginal ultrasound in a gynaecology clinic. Hum Reprod. 2012;27:3432–9.\nNaftalin J, Hoo W, Pateman K, Mavrelos D, Foo X, Jurkovic D. Is adenomyosis associated with menorrhagia? Hum Reprod. 2014;29:473–9.\nNaftalin J, Jurkovic D. The endometrial-myometrial junction: a fresh look at a busy crossing. Ultrasound Obstet Gynecol. 2009;34:1–11.\nNam JH, Lyu GS. Abdominal ultrasound-guided transvaginal myometrial core needle biopsy for the definitive diagnosis of suspected adenomyosis in 1032 patients: a retrospective study. J Minim Invasive Gynecol. 2014;11:1553–650.\nO’Shea A, Figueiredo G, Lee SI. Imaging diagnosis of adenomyosis. Semin Reprod Med. 2020;38:119–28.\nRasmussen CK, Hansen ES, Dueholm M. Inter-rater agreement in the diagnosis of adenomyosis by 2- and 3-dimensional trans- vaginal ultrasonography. J Ultrasound Med. 2019;38:657–66.\nRasmussen CK, Hansen ES, Ernst E, Dueholm M. Two- and three- dimensional transvaginal ultrasonography for diagnosis of adenomyosis of the inner myometrium. Reprod Biomed Online. 2019;38:750–60.\nReinhold C, McCarthy S, Bret PM, Mehio A, Atri M, Zakarian R, et al. Diffuse adenomyosis: comparison of endovaginal US and MR imaging with histopathologic correlation. Radiology. 1996;199:151–8.\nReinhold C, Tafazoli F, Mehio A, Wang L, Atri M, Siegelman ES, Rohoman L. Uterine adenomyosis: endovaginal US and MR imaging features with histopathologic correlation. Radiographics. 1999;19:S147–60.\nSam M, Raubenheimer M, Manolea F, et al. Accuracy of findings in the diagnosis of uterine adenomyosis on ultrasound. Abdom Radiol (NY). 2020;45:842–50.\nSammour A, Pirwany I, Usubutun A. Correlations between extent and spread of adenomyosis and clinical symptoms. Gynecol Obstet Investig. 2002;54:213e216.\nSiegler AM, Camilien L. Adenomyosis. J Reprod Med. 1994;39:841e853.\nTellum T, Nygaard S, Lieng M. Noninvasive diagnosis of adenomyosis: a structured review and meta-analysis of diagnostic accuracy in imaging. J Minim Invasive Gynecol. 2020;27:408–18.\nTomassetti C, Mueleman C, Timmerman D, D’Hooghe T. Adenomyosis and subfertility: evidence of association and causation. Semin Reprod Med. 2013;31:101–8.\nVan den Bosch T, Dueholm M, Leone FP, Valentin L, Rasmussen CK, Votino A, et al. Terms, definitions and measurements to describe sonographic features of the myometrium and uterine masses: a consensus opinion from the Morphological Uterus Sonographic Assessment (MUSA) group. Ultrasound Obstet Gynecol. 2015;46:284–29.\nVan den Bosch T, Van Schoubroeck D, Alcazar JL, Guerriero S, Martins W. The importance of transient myometrial contractions in the diagnosis of adenomyosis and congenital uterine anomalies. Ultrasound Obstet Gynecol. 2021;57(4):651–653.\nVan den Bosch T, de Bruijn AM, de Leeuw RA, Dueholm M, Exacoustos C, Valentin L, Bourne T, Timmerman D, Huirne JAF. Sonographic classification and reporting system for diagnosing adenomyosis. Ultrasound Obstet Gynecol. 2019;53:576–82.\nVercellini P, Consonni D, Dridi D, Bracco B, Frattaruolo MP, Somigliana E. Uterine adenomyosis and in vitro fertilization outcome: a systematic review and meta-analysis. Hum Reprod. 2014;29:964–7.\nVercellini P, Viganò P, Somigliana E, Daguati R, Abbiati A, Fedele L. Adenomyosis: epidemiological factors. Best Pract Res Clin Obstet Gynaecol. 2006;20:465–77.\nVercellini P, Cortesi I, De Giorgi O, Merlo D, Carinelli SG, Crosignani PG. Transvaginal ultrasonography versus uterine needle biopsy in the diagnosis of diffuse adenomyosis. Hum Reprod. 1998;13:2884–7.\nZannoni L, Ambrosio M, Raimondo D, Arena A, Del Forno S, Borghese G, Paradisi R, Seracchioli R. Question mark sign and transvaginal ultrasound uterine tenderness for the diagnosis of adenomyosis: a prospective validation. J Ultrasound Med. 2020;39:1405–12.\nZhai J, Vannuccini S, Petraglia F, Giudice LC. Adenomyosis: mechanisms and pathogenesis. Semin Reprod Med. 2020;38:129–43.\nDueholm M. Transvaginal ultrasound for diagnosis of adenomyosis: a review. Best Pract Res Clin Obstet Gynaecol. 2006;20:569–82.\nAuthor information\nAuthors and Affiliations\nCorresponding author\nEditor information\nEditors and Affiliations\nRights and permissions\nCopyright information\n© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG\nAbout this chapter\nCite this chapter\nExacoustos, C. (2022). Noninvasive Diagnosis of Adenomyosis: Ultrasonography. In: Oral, E. (eds) Endometriosis and Adenomyosis. Springer, Cham. https://doi.org/10.1007/978-3-030-97236-3_33\nDownload citation\nDOI: https://doi.org/10.1007/978-3-030-97236-3_33\nPublished:\nPublisher Name: Springer, Cham\nPrint ISBN: 978-3-030-97235-6\nOnline ISBN: 978-3-030-97236-3\neBook Packages: MedicineMedicine (R0)","source_license":"CC0","license_restricted":false}