{"paper_id":"6dc0a0c6-f4fe-4e4d-8bf4-74246d2b2e7d","body_text":"~ 1216 ~ \nInternational Journal of Clinical Obstetrics and Gynaecology 2026; 10(1): 1216-1219 \n \nISSN (P): 2522-6614 \nISSN (E): 2522-6622 \nIndexing: Embase \nImpact Factor (RJIF): 6.71 \n© Gynaecology Journal \nwww.gynaecologyjournal.com \n2026; 10(1): 1216-1219 \nReceived: 08-12-2025 \nAccepted: 11-01-2026 \n \nDr. Manisha Bhikhabhai Suthar \nAssociate Professor, Department of \nObstetrics and Gynaecology, Shree \nShankaracharya Institute of \nMedical Science, Bhilai, \nChhattisgarh, India \n \nDr. Subhashree Sethi  \nPost Doctoral Fellow Gynaecology, \nDepartment of Obstetrics and \nGynaecology, AIIMS \nBhubaneswar, Odisha, India \n \nDr. Kavar Bhavy \nMBBS, Department of Obstetrics \nand Gynaecology, UV Gullas \nCollege of Medicine, Philippines \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: \nDr. Kavar Bhavy \nMBBS, Department of Obstetrics \nand Gynaecology, UV Gullas \nCollege of Medicine, Philippines \n \nDiagnostic Accuracy of Transvaginal Ultrasonography \nVersus MRI in Early Detection of Adenomyosis \n \nManisha Bhikhabhai Suthar, Subhashree Sethi and Kavar Bhavy \n \nDOI: https://www.doi.org/10.33545/gynae.2026.v10.i1o.2006  \n \nAbstract \nBackground: Adenomyosis is a common gynecological  condition characterized by the invasion of \nendometrial glands and stroma into the myometrium. Early and accurate diagnosis remains challenging due \nto overlapping symptomatology with other uterine pathologies. Both transvaginal ultrasonography (TVS) \nand ma gnetic resonance imaging (MRI) are widely utilized non -invasive diagnostic modalities, yet \ncomparative evidence regarding their accuracy in early-stage adenomyosis detection remains limited. \nMethods: A prospective cross -sectional diagnostic accuracy study was conducted on 186 premenopausal \nwomen presenting with symptoms suggestive of adenomyosis. All participants underwent both TVS and \npelvic MRI prior to hysterectomy. Histopathological analysis of hysterectomy specimens served as the \ndefinitive diagnostic reference. Sensitivity, specificity, positive predictive value (PPV), negative predictive \nvalue (NPV), and overall diagnostic accuracy were calculated for both modalities. \nResults: Histopathology confirmed adenomyosis in 124 of 186 patients (66.7%). MRI de monstrated \nsuperior sensitivity (91.9% vs. 83.1%, p = 0.034), specificity (90.3% vs. 79.0%, p = 0.041), and overall \ndiagnostic accuracy (91.4% vs. 81.7%, p = 0.012) compared to TVS. The area under the receiver operating \ncharacteristic curve (AUC) was significantly higher for MRI (0.941) than for TVS (0.862, p = 0.008). MRI \nshowed particular superiority in detecting focal adenomyosis (sensitivity 89.5% vs. 68.4%, p = 0.018). \nConclusion: MRI demonstrates significantly higher diagnostic accuracy than TVS in th e early detection of \nadenomyosis, particularly for focal subtypes. However, TVS remains a valuable and accessible first -line \nscreening tool. \n \nKeywords: Adenomyosis, Transvaginal Ultrasonography , Magnetic Resonance Imaging , Diagnostic \nAccuracy, Early Detection, Histopathology \n \n1. Introduction  \nAdenomyosis is a benign gynecological disorder defined by the ectopic presence of endometrial \nglands and stroma within the myometrium, accompanied by surrounding smooth muscle \nhyperplasia and hypertrophy  [1]. The condi tion affects an estimated 20 -35% of women of \nreproductive age, although prevalence rates vary considerably depending on the diagnostic \ncriteria and population studied  [2]. Clinically, adenomyosis manifests with dysmenorrhea, \nmenorrhagia, chronic pelvic pai n, and subfertility, significantly impacting quality of life and \nreproductive outcomes [3]. \nHistorically, the definitive diagnosis of adenomyosis required histopathological examination of \nhysterectomy specimens, rendering preoperative diagnosis inherently challenging [4]. The advent \nof advanced imaging modalities has transformed the diagnostic landscape, enabling non -\ninvasive identification of adenomyosis prior to surgical intervention. Transvaginal \nultrasonography and magnetic resonance imaging have emerge d as the two principal imaging \ntechniques for this purpose [5]. \nTVS is widely accessible, cost -effective, and serves as the first -line imaging modality in \ngynecological practice. Characteristic sonographic features of adenomyosis include \nheterogeneous myom etrial echotexture, myometrial cysts, asymmetric myometrial thickening, \nsubendometrial echogenic linear striations, and a poorly defined endometrial -myometrial \njunction [6]. However, the diagnostic performance of TVS is operator -dependent and may be \nlimited in cases of coexistent uterine pathology such as leiomyomas [7]. \nMRI offers superior soft tissue contrast resolution and multiplanar imaging capability, \nfacilitating detailed evaluation of the junctional zone (JZ) and myometrial  architecture. A \njunctional zone thickness exceeding 12 mm is considered the most reliable MRI criterion for  \n\n\nInternational Journal of Clinical Obstetrics and Gynaecology https://www.gynaecologyjournal.com \n~ 1217 ~ \nadenomyosis diagnosis [8]. Several studies have reported high \nsensitivity and specificity for MRI in adenomyosis detection, \nwith values ranging from 78% to 93% and 67% to 99 %, \nrespectively [9]. \nDespite the growing body of literature on both modalities, \ncomparative studies evaluating their diagnostic performance \nspecifically in early -stage adenomyosis remain sparse. Early \ndetection is clinically significant because timely intervention can \npreserve fertility and improve symptom management  [10]. \nFurthermore, existing studies have yielded heterogeneous \nresults, partly attributable to differences in study design, \ndiagnostic criteria, and patient populations  [11]. A recent meta -\nanalysis highlighted the need for well -designed prospective \nstudies comparing TVS and MRI using standardized diagnostic \ncriteria and histopathological confirmation [12]. \nThe aim of this study was to prospectively compare the \ndiagnostic accuracy of TVS and MRI in the early detection of \nadenomyosis, utilizing histopathological analysis of \nhysterectomy specimens as the gold standard reference, and to \nevaluate the performance  of each modality across different \nsubtypes of the disease. \n \n2. Materials and Methods \nStudy Design and Setting \nThis prospective cross -sectional diagnostic accuracy study was \nconducted at the Department of Obstetrics and Gynecology.  \n \nStudy Population: A total of 186 premenopausal women aged \n30-50 years who presented with symptoms suggestive of \nadenomyosis (dysmenorrhea, menorrhagia, chronic pelvic pain, \nor dyspareunia) and were scheduled for hysterectomy for various \nbenign gynecological indications were enrolled consecutively. \nExclusion criteria included postmenopausal status, prior uterine \nsurgery other than cesarean section, known uterine malignancy, \ncontraindications to MRI (e.g., metallic implants, \nclaustrophobia), hormonal therapy within the preceding three \nmonths, and pregnancy. \n \nImaging Protocol \nAll participants underwent TVS followed by pelvi c MRI within \na two-week interval prior to hysterectomy. TVS was performed \nduring the early proliferative phase (cycle days 5 -10) using a \nhigh-resolution endovaginal transducer (5 -9 MHz) on a GE \nVoluson E10 ultrasound system. Examinations were conducted \nby two experienced sonologists (each with >10 years of \ngynecological ultrasound experience) who were blinded to MRI \nfindings. Standardized TVS diagnostic criteria for adenomyosis \nincluded heterogeneous myometrial echotexture, myometrial \ncysts, subendometrial linear striations, asymmetric myometrial \nthickening, and fan-shaped shadowing. \nPelvic MRI was performed using a 3.0 -Tesla scanner (Siemens \nMagnetom Prisma) with a phased-array pelvic coil. The imaging \nprotocol included T2-weighted turbo spin -echo sequences  in \nsagittal, coronal, and axial planes; T1-weighted sequences; and \ndiffusion-weighted imaging. Two experienced radiologists (>8 \nyears of pelvic MRI experience), blinded to TVS results and \nclinical data, independently evaluated the MRI images. MRI \ndiagnostic criteria included JZ thickness ≥12 mm, JZ maximum -\nto-minimum thickness ratio >2.2, presence of high -signal foci \nwithin the myometrium on T2-weighted images, and ill -defined \nlow-signal myometrial masses. \n \nHistopathological Examination: Hysterectomy specimens were\nprocessed according to standard protocols. Multiple systematic \nsections (minimum of four per specimen) were obtained from \nrepresentative areas. Histopathological diagnosis of \nadenomyosis was established when endometrial glands and \nstroma were ident ified at a depth of ≥2.5 mm from the \nendometrial-myometrial junction. A senior gynecological \npathologist, blinded to imaging results, rendered all diagnoses. \nAdenomyosis was further classified as diffuse or focal based on \nhistological distribution. \n \nStatistical Analysis \nSample size was calculated assuming a sensitivity of 85% for \nTVS and 92% for MRI with an alpha error of 0.05 and power of \n80%, yielding a minimum requirement of 170 subjects. \nContinuous variables were expressed as mean ± standard \ndeviation, a nd categorical variables were presented as \nfrequencies and percentages. Sensitivity, specificity, PPV, NPV, \nand overall accuracy were calculated for each modality with \n95% confidence intervals. McNemar's test was used to compare \npaired proportions. ROC cur ve analysis was performed, and \nAUC values were compared using the DeLong method. Inter -\nobserver agreement was assessed using Cohen's kappa \ncoefficient. A p -value <0.05 was considered statistically \nsignificant. All analyses were performed using SPSS version  \n28.0 and MedCalc version 20.1. \n \n3. Results \nDemographic and Clinical Characteristics \nThe mean age of the 186 enrolled participants was 41.3 ± 5.7 \nyears. The most common presenting symptom was menorrhagia \n(72.0%), followed by dysmenorrhea (65.6%) and chroni c pelvic \npain (48.9%). Histopathological examination confirmed \nadenomyosis in 124 patients (66.7%), of whom 86 (69.4%) had \ndiffuse adenomyosis and 38 (30.6%) had focal adenomyosis \n(Table 1). \n \nTable 1: Demographic and Clinical Characteristics of the Study \nPopulation (N = 186) \n \nVariable Value \nAge (years), mean ± SD 41.3 ± 5.7 \nBMI (kg/m²), mean ± SD 26.8 ± 4.2 \nParity, median (IQR) 2 (1-3) \nMenorrhagia, n (%) 134 (72.0%) \nDysmenorrhea, n (%) 122 (65.6%) \nChronic pelvic pain, n (%) 91 (48.9%) \nDyspareunia, n (%) 54 (29.0%) \nUterine volume (cm³), mean ± SD 142.6 ± 58.3 \nHistologically confirmed adenomyosis, n (%) 124 (66.7%) \nDiffuse adenomyosis, n (%) 86 (69.4%) \nFocal adenomyosis, n (%) 38 (30.6%) \nCoexistent leiomyomas, n (%) 47 (25.3%) \n \nDiagnostic Performance of TVS and MRI \nTVS correctly identified adenomyosis in 103 of 124 \nhistologically confirmed cases (sensitivity 83.1%) and correctly \nexcluded the condition in 49 of 62 non -adenomyosis cases \n(specificity 79.0%). MRI correctly identified 114 of 124  \nconfirmed cases (sensitivity 91.9%) and correctly excluded the \ncondition in 56 of 62 cases (specificity 90.3%). The overall \ndiagnostic accuracy was 81.7% for TVS and 91.4% for MRI (p \n= 0.012). The AUC was 0.862 (95% CI: 0.806 -0.918) for TVS \nand 0.941 (95% CI: 0.903-0.979) for MRI (p = 0.008) (Table 2). \n \n \n\nInternational Journal of Clinical Obstetrics and Gynaecology https://www.gynaecologyjournal.com \n~ 1218 ~ \nTable 2: Diagnostic Performance of TVS and MRI for Adenomyosis \nDetection (N = 186) \n \nParameter TVS (95% CI) MRI (95% CI) p-value \nTrue Positives 103 114 — \nTrue Negatives 49 56 — \nFalse Positives 13 6 — \nFalse Negatives 21 10 — \nSensitivity (%) 83.1 (75.4-89.1) 91.9 (85.7-96.0) 0.034 \nSpecificity (%) 79.0 (66.8-88.3) 90.3 (80.1-96.4) 0.041 \nPPV (%) 88.8 (81.6-93.8) 95.0 (89.3-98.1) 0.068 \nNPV (%) 70.0 (57.9-80.4) 84.8 (73.0-92.8) 0.027 \nOverall Accuracy (%) 81.7 (75.4-87.0) 91.4 (86.4-95.0) 0.012 \nAUC 0.862 (0.806-0.918) 0.941 (0.903-0.979) 0.008 \n \nSubtype Analysis and Inter-observer Agreement \nSubtype analysis revealed that MRI demonstrated markedly \nsuperior sensitivity for focal adenomyosis compared to TVS \n(89.5% vs. 68.4%, p = 0.018), while the difference was less \npronounced for diffuse adenomyosis (93.0% vs. 89.5%, p = \n0.312). Inter -observer agreement was substantial for TVS (κ = \n0.72) and almost perfect for MRI (κ = 0.89) (Table 3). \n \nTable 3: Diagnostic Performance by Adenomyosis Subtype and Inter-\nobserver Agreement \n \nParameter TVS MRI p-value \nDiffuse adenomyosis (n = 86)    Sensitivity (%) 89.5 93.0 0.312 \nSpecificity (%) 79.0 90.3 0.041 \nFocal adenomyosis (n = 38)    Sensitivity (%) 68.4 89.5 0.018 \nSpecificity (%) 79.0 90.3 0.041 \nCoexistent leiomyomas (n = 47)    Sensitivity (%) 74.3 88.6 0.029 \nSpecificity (%) 75.0 91.7 0.035 \nInter-observer agreement (κ) 0.72 0.89 — \nAgreement classification Substantial Almost perfect — \nIn cases with coexistent leiomyomas (n = 47), MRI maintained \nsignificantly higher sensitivity (88.6% vs. 74.3%, p = 0.029) and \nspecificity (91.7% vs. 75.0%, p = 0.035) compared to TVS. \n \n4. Discussion \nThe present study demonstrates that MRI possesses significantly \nsuperior diagnost ic accuracy compared to TVS in the early \ndetection of adenomyosis, with an overall accuracy of 91.4% \nversus 81.7%. These findings are consistent with previous \ninvestigations that have reported the enhanced capability of MRI \nin characterizing myometrial pat hology [13]. The higher spatial \nand contrast resolution of MRI facilitates precise evaluation of \nthe junctional zone, which is the anatomical hallmark affected in \nadenomyosis [14]. \nThe sensitivity of TVS observed in our study (83.1%) aligns \nclosely with th e pooled estimates reported in a comprehensive \nmeta-analysis by Stable and colleagues, who documented a \npooled sensitivity of 82.5% and specificity of 84.7% for TVS in \nadenomyosis diagnosis  [15]. Similarly, our MRI sensitivity of \n91.9% is concordant with t he findings of Champaneria et al ., \nwho reported a pooled MRI sensitivity of 90.0% in their \nsystematic review [16]. \nA particularly noteworthy finding of this study is the \nsignificantly superior performance of MRI in detecting focal \nadenomyosis (sensitivity 89.5% vs. 68.4%, p = 0.018). Focal \nadenomyosis, or adenomyoma, presents a well -recognized \ndiagnostic challenge on ultrasonography due to its \nmorphological resemblance to leiomyomas  [17]. The ability of \nMRI to delineate ill-defined borders, identify high-signal foci on \nT2-weighted sequences, and assess the junctional zone \nrelationship provides a distinct advantage in differentiating focal \nadenomyosis from leiomyomas [18]. \nThe diagnostic challenge posed by coexistent leiomyomas was \nfurther corroborated in our  subgroup analysis, where TVS \nsensitivity decreased to 74.3% in the presence of concomitant \nfibroids compared to 83.1% overall. MRI maintained robust \nperformance (88.6%) in this clinically relevant scenario. This \nfinding substantiates the observations of D ueholm and Lundorf, \nwho emphasized the limitations of TVS when adenomyosis \ncoexists with leiomyomas [19]. \nInter-observer agreement was substantially higher for MRI (κ = \n0.89) compared to TVS (κ = 0.72), reflecting the greater \nobjectivity and reproducibilit y of MRI interpretation. This \nfinding is clinically relevant, as the operator-dependent nature of \nultrasonography has been consistently identified as a limitation \nin adenomyosis diagnosis  [20]. Nonetheless, it should be \nacknowledged that the experience lev el of the sonologists may \nsubstantially influence TVS accuracy, and centers with \nspecialized expertise in gynecological ultrasound may achieve \nperformance levels closer to those of MRI [21]. \nDespite the statistical superiority of MRI, the clinical utility of \nTVS as a first -line screening modality should not be \nunderestimated. TVS is readily available, less expensive, well -\ntolerated by patients, and capable of real -time dynamic \nassessment. The concept of employing TVS as an initial \nscreening tool with select ive MRI referral for equivocal cases \nhas been advocated by several authors and appears to represent a \ncost-effective diagnostic strategy  [22]. Furthermore, recent \nadvances in sonographic techniques, including three -\ndimensional TVS and elastography, hold pr omise for improving \nthe diagnostic accuracy of ultrasound-based approaches [23]. \nThis study possesses several methodological strengths, including \nits prospective design, use of histopathological confirmation as \nthe reference standard, blinding of imaging i nterpreters, and \nstandardized diagnostic criteria. However, certain limitations \nwarrant acknowledgment. The study population was restricted to \nwomen undergoing hysterectomy, introducing potential selection \nbias toward more severe disease. Additionally, the  single-center \ndesign may limit generalizability. The exclusion of women \nreceiving hormonal therapy, while methodologically sound, may \nnot reflect routine clinical practice where many patients present \nwhile on medical management [24]. \n \n5. Conclusion \nThis p rospective diagnostic accuracy study demonstrates that \nMRI is significantly superior to TVS in the early detection of \nadenomyosis, exhibiting higher sensitivity, specificity, and \noverall diagnostic accuracy. The advantage of MRI is \nparticularly pronounced in the detection of focal adenomyosis \nand in cases complicated by coexistent leiomyomas. MRI also \ndemonstrates higher inter -observer reproducibility, supporting \nits role as the preferred confirmatory imaging modality. \nNevertheless, TVS remains a valuable, accessible, and cost -\neffective first -line screening tool in clinical practice. A tiered \ndiagnostic approach utilizing TVS for initial assessment with \nselective MRI referral for inconclusive or complex cases is \nrecommended to optimize diagnostic accuracy wh ile \nmaintaining clinical efficiency. Future multicenter studies \nincorporating fertility -sparing surgical outcomes and advanced \nultrasound techniques are warranted to further refine diagnostic \nalgorithms for adenomyosis. \n \nConflict of Interest \nNot available. \n\nInternational Journal of Clinical Obstetrics and Gynaecology https://www.gynaecologyjournal.com \n~ 1219 ~ \nFinancial Support  \nNot available. \n \nReferences \n1. Bird CC, McElin TW, Manalo -Estrella P. The elusive \nadenomyosis of the uterus —revisited. Am J Obstet \nGynecol. 1972;112(5):583-593. \n2. Struble J, Reid S, Bedaiwy MA. Adenomyosis: A clinical \nreview of a challenging gynecologic condition. J Minim \nInvasive Gynecol. 2016;23(2):164-185. \n3. Chapron C, Tosti C, Marcellin L, et al . Relationship \nbetween the magnetic resonance imaging appearance of  \nadenomyosis and endometriosis phenotypes. Hum Reprod. \n2017;32(7):1393-1401. \n4. Gordts S, Brosens JJ, Fusi L, Benagiano G, Brosens I. \nUterine adenomyosis: A need for uniform terminology and \nconsensus classification. Reprod Biomed Online. \n2008;17(2):244-248. \n5. Tellum T, Nygaard S, Lieng M. Noninvasive diagnosis of \nadenomyosis: A structured review and meta -analysis of \ndiagnostic accuracy in imaging. J Minim Invasive Gynecol. \n2020;27(2):408-418.e3. \n6. Van den Bosch T, Dueholm M, Leone FPG, et al. Terms, \ndefinitions and measurements to describe sonographic \nfeatures of myometrium and uterine masses: A consensus \nopinion from the Morphological Uterus Sonographic \nAssessment (MUSA) group. Ultrasound Obstet Gynecol. \n2015;46(3):284-298. \n7. Naftalin J, Hoo W, Pateman K , Mavrelos D, Holland T, \nJurkovic D. How common is adenomyosis? A prospective \nstudy of prevalence using transvaginal ultrasound in a \ngynaecology clinic. Hum Reprod. 2012;27(12):3432-3439. \n8. Reinhold C, Tafazoli F, Mehio A, et al . Uterine \nadenomyosis: Endo vaginal US and MR imaging features \nwith histopathologic correlation. Radiographics. \n1999;19(Suppl 1):S147-S160. \n9. Bazot M, Cortez A, Darai E, et al . Ultrasonography \ncompared with magnetic resonance imaging for the \ndiagnosis of adenomyosis: Correlation wit h histopathology. \nHum Reprod. 2001;16(11):2427-2433. \n10. Vannuccini S, Tosti C, Cicinelli E, et al . Infertility and \nadenomyosis. Best Pract Res Clin Obstet Gynaecol. \n2017;46:35-46. \n11. Dueholm M. Uterine adenomyosis and infertility, review of \nreproductive outcome after in vitro fertilization and surgery. \nActa Obstet Gynecol Scand. 2017;96(6):715-726. \n12. Stable G, Temtanakitpaisan T, Enghelabifar M, et al . \nDiagnostic accuracy of sonography for adenomyosis: \nSystematic review and meta -analysis. Ultrasound Obstet  \nGynecol. 2022;60(3):309-325. \n13. Exacoustos C, Brienza L, Di Giovanni A, et al . \nAdenomyosis: Three -dimensional sonographic findings of \nthe junctional zone and correlation with histology. \nUltrasound Obstet Gynecol. 2011;37(4):471-479. \n14. Novellas S, Chassan g M, Delotte J, et al . MRI \ncharacteristics of the uterine junctional zone: From normal \nto the diagnosis of adenomyosis. AJR Am J Roentgenol. \n2011;196(5):1206-1213. \n15. Stable G, Temtanakitpaisan T, Henrich W, Enghelabifar M. \nAccuracy of ultrasonography in t he diagnosis of \nadenomyosis: Systematic review and meta -analysis. \nUltrasound Obstet Gynecol. 2022;60(3):309-325. \n16. Champaneria R, Abedin P, Daniels J, Pattison H, Khan KS. \nUltrasound scan and magnetic resonance imaging for the \ndiagnosis of adenomyosis: Sy stematic review comparing \ntest accuracy. Acta Obstet Gynecol Scand. \n2010;89(11):1374-1384. \n17. Tamai K, Togashi K, Ito T, Morisawa N, Fujiwara T, \nKoyama T. MR imaging findings of adenomyosis: \nCorrelation with histopathologic features and diagnostic \npitfalls. Radiographics. 2005;25(1):21-40. \n18. Bazot M, Darai E. Role of transvaginal sonography and \nmagnetic resonance imaging in the diagnosis of uterine \nadenomyosis. Fertil Steril. 2018;109(3):389-397. \n19. Dueholm M, Lundorf E. Transvaginal ultrasound or MRI \nfor diagnosis of adenomyosis. Curr Opin Obstet Gynecol. \n2007;19(6):505-512. \n20. Dueholm M, Lundorf E, Hansen ES, Sørensen JS, \nLedertoug S, Olesen F. Magnetic resonance imaging and \ntransvaginal ultrasonography for the diagnosis of \nadenomyosis. Fertil Steril. 2001;76(3):588-594. \n21. Alcázar JL, Kissling GE, Galván R, Guerriero S. Three -\ndimensional ultrasound in gynecological clinical practice. \nUltrasound Obstet Gynecol. 2018;51(1):148-150. \n22. Sharma K, Bora MK, Venkatesh BP, et al. Role of MRI in \ndiagnosis of adeno myosis. Indian J Radiol Imaging. \n2013;23(1):39-44. \n23. Liu X, Ding D, Ren Y, et al. Transvaginal elastography for \nthe diagnosis of adenomyosis: A systematic review and \nmeta-analysis. Eur J Obstet Gynecol Reprod Biol. \n2021;267:46-52. \n24. Abbott JA. Adenomyosi s and abnormal uterine bleeding \n(AUB-A)—pathogenesis, diagnosis, and management. Best \nPract Res Clin Obstet Gynaecol. 2017;40:68-81. \n \nHow to Cite This Article \nSuthar MB, Sethi S, Bhavy K. Diagnostic Accuracy of Transvaginal \nUltrasonography Versus MRI in Early Detection of Adenomyosis . \nInternational Journal of Clinical Obstetrics and Gynaecology . 2026; \n10(1):1216-1219.  \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 rem ix, \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}