{"paper_id":"3e14092f-6a20-470e-90ca-09f3cf691776","body_text":"~ 1506 ~ \nInternational Journal of Clinical Obstetrics and Gynaecology 2026; 10(3): 1506-1512 \n \nISSN (P): 2522-6614 \nISSN (E): 2522-6622 \nIndexing: Embase \nImpact Factor (RJIF): 6.71 \n© Gynaecology Journal \nwww.gynaecologyjournal.com \n2026; 10(3): 1506-1512 \nReceived: 08-03-2026 \nAccepted: 10-04-2026 \n \nKajal Singh  \nAssociate Professor, Department of \nObstetrics and Gynaecology, Noida \nInternational Institute of Medical \nScience, Greater Noida, Uttar \nPradesh, India \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \nCorresponding Author: \nKajal Singh  \nAssociate Professor, Department of \nObstetrics and Gynaecology, Noida \nInternational Institute of Medical \nScience, Greater Noida, Uttar \nPradesh, India \n \nComparative study of transvaginal ultra sonography \nversus MRI in early detection of adenomyosis  \n \nKajal Singh  \n \nDOI: https://www.doi.org/10.33545/gynae.2026.v10.i3t.2437  \n \nAbstract \nBackground Adenomyosis is a benign gynaecological disorder defined by ectopic presence of endometrial \nglands and stroma. True prevalence of adenomyosis is difficult to determine because some women are \nasymptomatic and it non -specifically mimics other uterine pathology. Hence, non -invasive techniques, \nTVUS and MRI were used to study and compare the proper diagnosis of adenomyosis. \nMethod: 60 (sixty) premenopausal women having suggestive symptoms of adenomyosis,  underwent TVS \nfollowed by MRI within a two-week interval prior to hysterectomy using TVS high -resolution endovaginal \ntransducer (5 -9 MHz) on a GE Voluson S8 ultrasound system. A pelvic MRI was performed using 1.5 \nTesla scanners (GE SIGNA creator). The hysterectomy specimen was proces sed and studied according to \nstandard protocol. \nResults: Comparison of diagnostic performance of TVUS versus MRI for adenomysis detection. True \npositive, true negative, false positive, and false negative had high rates of MRI detection. And more \nsensitivity, specificity, PPV, NPV, and overall accuracy (AUS) were observed in the MRI study. 41 \ndiffused adenomyosis, 23 focal adenomyosis, co-existence of leiomyomas, and interobserver agreement (k) \nhad a significant p value (p<0.005), and the MRI study was almost perfect. \nConclusion: MRI study demonstrates significantly higher diagnostic accuracy than TVUS, but TVUS can \nbe used as a first-line screening tool. \n \nKeywords: TVUS, MRI, Specificity, sensitivity, benign adenemyosis, Histo-pothology \n \nIntroduction  \nAdenomyosis is a benign gynaecological disorder where ectopic endometrium is present within \nthe myometrial wall of the uterus. The true prevalence of adenomyosis is difficult to determine \nbut has been quoted to range from 5 to 70% among hysterectomy specimens de pending on the \nbaseline demographics and population sampled [1]. While some women are asymptomatic, the \nclassic symptoms of adenomyosis are pain and heavy menstrual bleeding; it can be associated \nwith infertility [2]. The clinical diagnosis of adenomyosis is challenging, as signs and symptoms \nof adenomyosis are non -specific and may mimic other uterine pathology. It is paramount that a \nnon-invasive diagnosis is achievable for women, especially those who wish for conservative \nmanagement or to preserve their fertility [3]. \nBoth ultrasound and magnetic imaging (MRI) have been used to provide a non -invasive \ndiagnosis. Ultrasound, especially transvaginal ultrasound (TVUS), is often the first line of \ndiagnosis of adenomyosis. MRI can be useful in defining the exten t and location of \nadenomyosis. Like three -dimensional (3D) ultrasound, the zonal anatomy of the uterus is well \ndemonstrated on a T2-weighted image [4]. Hence, images of adenomyosis were observed, studied \nand compared in TVS and MRI and confirmed by histopathological study. \n \nMaterial and Method \n60 (sixty) adult premenopausal women aged between 30 -48 years who regularly visited SKS \nMedical College, research center, and hospital, Mathura, Uttar Pradesh-281406 were studied. \n \nInclusion Criteria \nPatients who pres ented symptoms suggestive of adenomyosis and scheduled for hysterectomy \nfor various benign gynaecological indications. The patients who gave their consent in writing for \nstudy were selected.  \n \n \n\n\nInternational Journal of Clinical Obstetrics and Gynaecology https://www.gynaecologyjournal.com \n~ 1507 ~ \nExclusion Criteria \nPatients with post-menopausal status, prior uterine surgery other \nthan caeserian section. Malignant uterus patient’s \ncontraindications to MRI (e.g., metallic implants, \nclaustrophobia), hormonal therapy within the preceding three \nmonths, and pregnancy were excluded from studies. \n \nMethod \nImaging pr otocol: All patients underwent TVS followed by \npelvic MRI within two weeks interval prior to hysterectomy. \nTVS was performed during the early proliferative phase (cycle \ndays 5 -10) using a high -resolution endovaginal transducer (5 -9 \nMHz) on a GE Voluson S8 ultrasound system. Examinations \nwere conducted using standardized TVS diagnostic criteria for \nadenomyosis, which included heterogeneous myometrial \nechotexture, myometrial cysts, subendometrial linear striations, \nand asymmetric myometrium. Standardized TVS diagnosis \ncriteria for adenomyometrial echofexture, myometrial cysts, \nsubendometrial linear striations, asymmetric striations, \nasymmetric myometrial thickening, and fan shaped shadowing. \nA pelvic MRI was performed (GE SIGNA Creators 1.5 tesla) \nwith a phase d array pelvic coil the imaging protocol coil. The \nimaging protocol included T2 -weighted turbo spin -echo \nsequences in sagittal, coronal, and axial planes; T1 weighted \nsequences and diffusing weighted sequences. MRI Diagnosis \ncriteria included JZ minimum th ickness ratio >2.2, the presence \nof high -signal foci within the myometrium on a T2 -weighted \nimages, and ill -defined low -signal myometrial foci within the \nmyometrial masses. \n  \nHistopathology examination \nHysterectomy specimens were processed according to sta ndard \nprotocols. Multiple systemic sections (minimum four per \nspecimen) were obtained from representative area. \nHistopathological diagnoses of adenomyosis were established \nwhen endometrial glands and stroma were identified at a depth \nof >2.5 mm from the en dometrial-myometrial junction. \nAdenomyosis was further classified as diffuse or focal based on \nhistological distribution.  The duration of study was from \nNovember 2022 to August 2023. \n \nStatistical Analysis \nThe sample size of 60 (sixty) patients was compared  and \ncalculated, assuming a sensitivity of 85% for TVS and 92% for \nMRI with an alpha error of 0.05 and a power of 80%, yielding a \nminimum requirement of 50 subjects. Sensitivity, specificity, \nPPV, NPV, and overall accuracy were calculated for each \nmodality with 95% confidence intervals. The McNemar's test \nwas used to compare paired proportions. ROC curve analysis \nwas performed. AUC values were compared using the De Lang \nmethod. Interobserver reliability using Cohen's kappa \ncoefficient. A p -value (p < 0.005)  was considered statistically \nsignificant. Statistical analysis was carried out in SPSS software \nversion 28.0 and MedCalc version 20.1. \n \n \n \nFig 1: Transvaginal ultrasound images of adenomyosis highlighting the diagnostic criteria. \n \n \n \nFig 2: Magnetic resonance images of adenomyosis highlighting the \ndiagnostic criteria. \nObservation and Results \n1. Table 1:  Clinical manifestations: 2 (1 -3) parity Median \n(ICR), 43 (71.6%) Menorragia, 39 (65%) Dsymenorrhea, 29 \n(48.3%) Chronic pelvic pain, 17 (28.3%) Dyspareunia,  \n142.4 (±12.8) uterine volume (cm3) (mean ±SD), 40 \n(66.6%) Histologically confirmed adenomyosis, 41 (68.3%) \ndiffuse adenomyosis, 23 (38.3%) focaladenomyosis, 15 \n(25%) co-existance adinomyosis  \n2. Table 2:  Diagnostic performance of TVS versus MRI for \nadenomyosis detection True positive, True negative, False \nnegative, False positive value percentage were quite higher \nin MRI. \nSensitivity percentage and specificity percentage studied \nhad higher percentage MRI values were observed PPV (%), \nNPV (%) and overall accur acy and AUC also had \nsignificant values in MRI as compared to TVS.  \n\nInternational Journal of Clinical Obstetrics and Gynaecology https://www.gynaecologyjournal.com \n~ 1508 ~ \n3. Table 3: Study of diagnostic performance by Adenomyosis \nsubtype and inter observer agreement: Diffuse adenomyosis, \nFocal adenomyosis, co -existance Leiomyomas, Inter -\nobserver agreement MRI increased p value and significant p \nvalue (p<0.001). MRI had almost perfect agreement as \ncompared to TVS studies (p<0.001). \n \nDiscussion \nPresent a comparative study of transvaginal ultrasonography \nversus MRI in early detection of adenomyosis. The clinical \nmanifestations were 2 (1 -3) parity, 43 (71.6%) menorrhagia, 39 \n(65%) dysmenorrhea, 29 (48.3%) chronic pelvic pain, 17 \n(28.3%) dyspareunia, 142.4 (±12.8) uterine volume, 40 (66.6%) \nhistologically confirmed adenomyosis, 41 (68.3%) diffuse \nadenomyosis, 23 (38. 3%) focal adenomyosis, and 15 (25%) co -\nexistent leiomyomas (Table 1). The comparative study of \ndiagnostic performance of TVUS versus MRI for adenomyosis \ndetection as true positive, true negative, false positive, and false \nnegative has increased performance  in MRI studies. Moreover, \nspecificity, sensitivity, PPV, NPV, overall accuracy, and AUC \nhad more significant values that were observed in MRI studies \n(Table 2). In a comparative study of diagnostic performance by \nadenomyosis subtype and interobserver agre ement study, \naccurate diagnosis was observed in MRI more than TVUS \nstudies, with higher sensitivity and specificity observed in \ndiffuse adenomyosis and focal adenomyosis; coexistence of \nleiomyosis was observed in MRI studies (Table 3) and (Figures \n1 and 2) . These findings are more or less in agreement with \nprevious studies [5, 6, 7]. \nTVUS is a more cost -effective and readily available imaging \ntechnique that is generally well tolerated by most patients. MRI, \non the other hand, is advantageous, as the images produced are \nin standard planes, resulting in more reproducibility among \nstudies [8]. It has also long been regarded as the imaging \nmodality of choice in evaluating zonal anatomy [9]. However, its \nuse is limited by factors such as morbid obesity or \nclaustrophobia. MRI is generally reserved as a second line for \nthe diagnosis of adenomyosis, mainly after a non -conclusive \nultrasound study [10]. \nMoreover correlation to a histopathological meant a more \naccurate analysis of the index test, as the current gold sta ndard is \nhistology via hysterectomy, especially in regard to fertility [11]. \n \nSummary and Conclusion \nIt is proved that TVUS is more cost -effective, widely available, \nand easily accessible; it is likely to remain the first imaging \nmodality of choice, defaul ting to an MRI where ultrasound is \ndifficult or inconclusive. More studies are required to evaluate \nthe different ultrasound modalities, further including \nelastography and 3D TVUS. Future research is needed to \nevaluate the individual MUSA (morphological ut erus \nsonographic assessment) criteria and adopt standardized \nreporting guidelines. \n \nLimitation of study: Owing to remote location of research \ncentre, small number of patients, lack of latest techniques, we \nhave limited findings and results \n This research wo rk was approved by the ethical committee \nof SKS Medical College, research center, and hospital, \nMathura, Uttar Pradesh-281406 \n No Conflict of Interest \n Self Funding \n \nTable 1: Clinical manifestations of the adenomyosis patients \n \nClinical Manifestations Variables  Value \nParity Median (TQR) 2 (1-3) \nMennorragia (N)(%) 43 (71.6%)  \nDysmenorrhea N (%) 39 (65%)  \nChronic Palvic Pain N (%) 29 (48.3%) \nDyspareunia N (%) 17 (28.3%) \nUterine volume (cm3), Mean (±SD) 142.4 (±12.8) \nHistological confirmed adenomyosis N (%) 40 (66.6%) \nDiffuse adenomyosis N (%) 41 (68.3%) \nFocal adenomyosis N (%) 23 (38.3%) \nCoexistent leiomyomas 15 (25%) \n \n\n\nInternational Journal of Clinical Obstetrics and Gynaecology https://www.gynaecologyjournal.com \n~ 1509 ~ \nTable 2: Comparison of Diagnostic performance of TVUS versus MRI for adenomyosis detection \n \nParameter TVS (95%) CI MRI (95%) CI p value \nTrue positive 33 37 -- \nTrue Negatives 16 18 -- \nFalse Positives 4 3 -- \nFalse Negative 7 2 -- \nSensitivity (%) 83 (73.2 – 84.1) 90.8 (83.5 – 94.7) 0.032 \nSpecificity (%) 78.4 (65.4 – 88.2) 90.2 (80-96.2) 0.038 \nPPV (%) 88.6 (80.5 – 92.3) 95.0 (88.2 – 98.2) 0.016 \nNPV (%) 70.0 (55.8 – 80.2) 84.4 (72.0 – 90.4) 0.025 \nOverall accuracy 81.5 (73.2 – 85.0) 91.2 (84.2 – 95.0) 0.001 \nAUC 0.841 (0.78 – 0.916) 0.940 (0.901 – 977) 0.006 \n \n \n \nTable 3: Study of diagnostic performance by Adenomyosis subtype and inter observer agreement \n \nParameter TVS MRI p value \nDiffuse adenomyosis (n=41) \nSensitivity 89.2 92.0 0.314 \nSpecificity 78.0 90.1 0.04 \nFocal adenomyosis (n=23) \nsensitivity 68.2 89.2 0.0016 \nSpecificity 78.0 90.1 0.042 \nCoexistence Leiomyomas (n=15) \nSensitivity (%) 74.1 88.4 0.027 \nSpecificity (%) 75.0 91.5 0.034 \nInter-observer agreement (K) 0.70 0.87 -- \nAgreement classification Subsntial Almost perfect -- \n \nIn the cases of Co -existent leiomyomas (N=15) MRI maintained \nsignificantly higher sensitivity  (88.4%) versus 74.1% p value \n0.027 (p<0.002) (highly significant) (p<0.002) and specificity \n91.5% in MRI versus 75% TVS study and p value 0.034 \n(p<0.003) p value is highly significant.  \n \n \n \n \n \n \n \n \n \n \n \n \n\nInternational Journal of Clinical Obstetrics and Gynaecology https://www.gynaecologyjournal.com \n~ 1510 ~ \n \n \n \nConflict of Interest \nNot available  \n \nFinancial Support  \nNot available \n \nReferences \n1. 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Ultrasound scan and magnetic resonance imaging for \nthe diagnosis of a denomyosis: systematic review comparing \ntest accuracy. Acta Obstet Gynecol Scand. \n2010;89(11):1374–1384. \n \n \nHow to Cite This Article \nSingh K. Comparative study of transvaginal ultra sonography versus MRI \nin early detection of adenomyosis . International Jou rnal of Clinical \nObstetrics and Gynaecology. 2026;10(3):1506-1512.  \n \n \nCreative Commons (CC) License \nThis is an open access journal, and articles are distributed under the terms \nof the Creative Commons Attribution -Non-Commercial-Share Alike 4.0 \nInternational (CC BY-NC-SA 4.0) License, which allows others to remix, \ntweak, and build upon the work non -commercially, as long as appropriate \ncredit is given and the new creations are licensed under the identical terms.","source_license":"CC0","license_restricted":false}