{"paper_id":"73de4168-bb15-45da-9706-ad2759a1b068","body_text":"Abstract\nAdenomyosis is a common, estrogen-dependent condition where endometrial tissue grows within the myometrium, often accompanied by smooth muscle hypertrophy. Initially thought to represent a condition primarily seen in multiparas with menorrhagia, and dysmenorrhea, adenomyosis is now increasingly recognized in younger patients and those with infertility and subfertility. As a result, conservative treatments aimed at preserving the uterus and improving reproductive outcomes have gained attention to treat adenomyosis. While research has largely focused on managing abnormal uterine bleeding and dysmenorrhea, there is limited evidence on the treatment of infertility associated with adenomyosis, particularly in terms of imaging follow-up. This paper reviews the emerging literature, highlighting key imaging findings before and after uterus-preserving treatments for adenomyosis, to better inform management and decision-making.\nGraphical Abstract\nSimilar content being viewed by others\nData availability\nNo datasets were generated or analysed during the current study.\nReferences\nSelntigia A, Molinaro P, Tartaglia S, Pellicer A, Galliano D, Cozzolino M. Adenomyosis: An Update Concerning Diagnosis, Treatment, and Fertility. J Clin Med. 2024;13(17).\nLiu L, Li W, Leonardi M, Condous G, Da Silva Costa F, Mol BW, et al. Diagnostic Accuracy of Transvaginal Ultrasound and Magnetic Resonance Imaging for Adenomyosis: Systematic Review and Meta-Analysis and Review of Sonographic Diagnostic Criteria. J Ultrasound Med. 2021;40(11):2289–306.\nHarmsen MJ, Van den Bosch T, de Leeuw RA, Dueholm M, Exacoustos C, Valentin L, et al. Consensus on revised definitions of Morphological Uterus Sonographic Assessment (MUSA) features of adenomyosis: results of modified Delphi procedure. Ultrasound Obstet Gynecol. 2022;60(1):118–31.\nHenshaw J, Tremellen K. Intralipid infusion therapy as an adjunct treatment in women experiencing adenomyosis-related infertility. Ther Adv Reprod Health. 2023;17:26334941231181258.\nBazot M, Daraï E. Role of transvaginal sonography and magnetic resonance imaging in the diagnosis of uterine adenomyosis. Fertil Steril. 2018;109(3):389–97.\nHuang Y, Zhao X, Chen Y, Wang J, Zheng W, Cao L. Miscarriage on Endometriosis and Adenomyosis in Women by Assisted Reproductive Technology or with Spontaneous Conception: A Systematic Review and Meta-Analysis. Biomed Res Int. 2020;2020:4381346.\nRocha TP, Andres MP, Borrelli GM, Abrão MS. Fertility-Sparing Treatment of Adenomyosis in Patients With Infertility: A Systematic Review of Current Options. Reprod Sci. 2018;25(4):480–6.\nEtrusco A, Barra F, Chiantera V, Ferrero S, Bogliolo S, Evangelisti G, et al. Current Medical Therapy for Adenomyosis: From Bench to Bedside. Drugs. 2023;83(17):1595–611.\nVan den Bosch T, de Bruijn AM, de Leeuw RA, Dueholm M, Exacoustos C, Valentin L, et al. Sonographic classification and reporting system for diagnosing adenomyosis. Ultrasound Obstet Gynecol. 2019;53(5):576–82.\nDonnez J, Donnez O, Dolmans MM. Introduction: Uterine adenomyosis, another enigmatic disease of our time. Fertil Steril. 2018;109(3):369–70.\nSW Y, NL R, RM K. Adenomyosis: Transvaginal Ultrasound and Imaging Innovations for Diagnosis. 2023. p. 178– 85.\nNovellas S, Chassang M, Delotte J, Toullalan O, Chevallier A, Bouaziz J, et al. MRI characteristics of the uterine junctional zone: from normal to the diagnosis of adenomyosis. AJR Am J Roentgenol. 2011;196(5):1206–13.\nStratopoulou CA, Donnez J, Dolmans MM. Conservative Management of Uterine Adenomyosis: Medical vs. Surgical Approach. J Clin Med. 2021;10(21).\nStanekova V, Woodman RJ, Tremellen K. The rate of euploid miscarriage is increased in the setting of adenomyosis. Hum Reprod Open. 2018;2018(3):hoy011.\nKitamura Y, Allison SJ, Jha RC, Spies JB, Flick PA, Ascher SM. MRI of adenomyosis: changes with uterine artery embolization. AJR Am J Roentgenol. 2006;186(3):855–64.\nPelage JP, Jacob D, Fazel A, Namur J, Laurent A, Rymer R, et al. Midterm results of uterine artery embolization for symptomatic adenomyosis: initial experience. Radiology. 2005;234(3):948–53.\nMa J, Brown B, Liang E. Long-term durability of uterine artery embolisation for treatment of symptomatic adenomyosis. Aust N Z J Obstet Gynaecol. 2021;61(2):290–6.\nKröncke T. An update on uterine artery embolization for uterine leiomyomata and adenomyosis of the uterus. Br J Radiol. 2023;96(1143):20220121.\nLiu L, Wang T, Lei B. Image-guided thermal ablation in the management of symptomatic adenomyosis: a systematic review and meta-analysis. Int J Hyperthermia. 2021;38(1):948–62.\nYuan K, Zhang JL, Yan JY, Yuan B, Fu JX, Wang Y, et al. Uterine Artery Embolization with Small-Sized Particles for the Treatment of Symptomatic Adenomyosis: A 42-Month Clinical Follow-Up. Int J Gen Med. 2021;14:3575–81.\nBae SH, Kim MD, Kim GM, Lee SJ, Park SI, Won JY, et al. Uterine Artery Embolization for Adenomyosis: Percentage of Necrosis Predicts Midterm Clinical Recurrence. J Vasc Interv Radiol. 2015;26(9):1290-6.e2.\nKim MD, Kim S, Kim NK, Lee MH, Ahn EH, Kim HJ, et al. Long-term results of uterine artery embolization for symptomatic adenomyosis. AJR Am J Roentgenol. 2007;188(1):176–81.\nXu F, Lin Z, Wang Y, Gong C, He M, Guo Q, et al. Comparison of high-intensity focused ultrasound for the treatment of internal and external adenomyosis based on magnetic resonance imaging classification. Int J Hyperthermia. 2023;40(1):2211268.\nCapezzuoli T, Toscano F, Ceccaroni M, Roviglione G, Stepniewska A, Fambrini M, et al. Conservative surgical treatment for adenomyosis: New options for looking beyond uterus removal. Best Pract Res Clin Obstet Gynaecol. 2024;95:102507.\nPinho Oliveira MA, Raymundo TS, Moawad G, Pereira TD, Alves JC, Brandão A. A stepwise approach to robotic diffuse adenomyosis resection with double flap and concomitant abdominal cerclage. Fertil Steril. 2022;118(5):987–9.\nXie M, Yu H, Zhang X, Wang W, Ren Y. Elasticity of adenomyosis is increased after GnRHa therapy and is associated with spontaneous pregnancy in infertile patents. J Gynecol Obstet Hum Reprod. 2019;48(10):849–53.\nBurla L, Sartoretti E, Mannil M, Seidel S, Sartoretti T, Krentel H, et al. MRI-Based Radiomics as a Promising Noninvasive Diagnostic Technique for Adenomyosis. J Clin Med. 2024;13(8).\nAcknowledgements\nThe authors would like to thank Maria Clara Gomes Cabral de Souza for the illustrations and Alice Brandão, MD, and Marco Aurélio Pinho de Oliveira, MD, for kindly providing images used in this paper.\nAuthor information\nAuthors and Affiliations\nContributions\nB.C.O. and L.P.C. structured the outline.B.C.O., M.K.F., P.J., and S.Y. wrote the main manuscript.B.C.O. prepared all figures.P.J., A.S.C., and L.P.C. reviewed the manuscript.\nCorresponding authors\nEthics declarations\nCompeting interests\nThe authors declare no competing interests.\nAdditional information\nPublisher’s note\nSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.\nRights and permissions\nSpringer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.\nAbout this article\nCite this article\nOliveira, B., Feldman, ., Jha, P. et al. Treatment-related changes in adenomyosis: a primer for radiologists. Abdom Radiol 50, 4359–4373 (2025). https://doi.org/10.1007/s00261-025-04866-3\nReceived:\nRevised:\nAccepted:\nPublished:\nVersion of record:\nIssue date:\nDOI: https://doi.org/10.1007/s00261-025-04866-3","source_license":"CC0","license_restricted":false}