{"paper_id":"e3d927f6-220e-4cc7-bd87-ec018b9b2680","body_text":"Abstract\nObjective(s)\nThis study aims to assess the diagnostic accuracy of the revised Morphologic Uterus Sonographic Assessment (MUSA) criteria for adenomyosis.\nMethods\nRetrospective review on 96 patients who underwent hysterectomy following ultrasound assessment between 1/3/2020–11/30/2023 for clinical reasons. Two blinded physician reviewers independently evaluated ultrasound images using the modified MUSA criteria. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and interrater reliability of the modified MUSA criteria were determined using hysterectomy specimens as the reference gold standard.\nResults\nReviewer 1 found the modified MUSA criteria were found to have a sensitivity of 63.2%, specificity of 65.5%, PPV of 54.4%, and NPV of 73.1%. For reviewer 2, sensitivity was 42.1%, specificity 62.1%, PPV 42.1%, and NPV 62.1%. Interrater agreement using Cohen’s kappa was 72.9%.\nConclusion(s)\nThe modified MUSA criteria demonstrate moderate sensitivity and specificity in diagnosing adenomyosis. Inter-rater agreement was moderate with 72.9% concordance between ultrasound examiners. While useful in clinical assessment, this study suggests that the modified MUSA criteria lack high specificity and sensitivity, limiting their standalone diagnostic reliability.\nSimilar content being viewed by others\nData availability\nNo datasets were generated or analysed during the current study.\nReferences\nHabiba M, Guo S-W, Benagiano G. Adenomyosis and abnormal uterine bleeding: review of the evidence. Biomolecules. 2024;14(6):616. https://doi.org/10.3390/biom14060616\nVannuccini S, Tosti C, Carmona F, Huang SJ, Chapron C, Guo SW, Petraglia F. Pathogenesis of adenomyosis: an update on molecular mechanisms. Reprod Biomed Online. 2017;35(5):592–601. https://doi.org/10.1016/j.rbmo.2017.06.016\nNirgianakis K, Kalaitzopoulos DR, Schwartz ASK, et al. Fertility, pregnancy and neonatal outcomes of patients with adenomyosis: a systematic review and meta-analysis. Reprod Biomed Online. 2021;42(1):185–206. https://doi.org/10.1016/j.rbmo.2020.09.023.\nStruble J, Reid S, Bedaiwy MA. Adenomyosis: a clinical review of a challenging gynecologic condition. J Minim Invasive Gynecol. 2016;23(2):164–185. https://doi.org/10.1016/j.jmig.2015.09.018\nSchrager S, Yogendran L, Marquez CM, Sadowski EA. Adenomyosis: diagnosis and management. Am Fam Physician. 2022;105(1):33–38\nSquillace ALA, Simonian DS, Allegro MC, Borges E Júnior, Bianchi PHM, Bibancos M. Adenomyosis and in vitro fertilization impacts - A literature review. JBRA Assist Reprod. 2021;25(2):303–309. https://doi.org/10.5935/1518-0557.20200104\nVan den Bosch T, de Bruijn AM, de Leeuw RA, et al. Sonographic classification and reporting system for diagnosing adenomyosis. Ultrasound Obstet Gynecol. 2019;53(5):576–582. https://doi.org/10.1002/uog.19096.\nHarmsen MJ, Van den Bosch T, de Leeuw RA, 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):118–131. https://doi.org/10.1002/uog.24786\nAlcázar JL, Vara J, Usandizaga C, Ajossa S, Pascual MÁ, Guerriero S. Transvaginal ultrasound versus magnetic resonance imaging for diagnosing adenomyosis: A systematic review and head-to-head meta-analysis. Int J Gynaecol Obstet. 2023;161(2):397–405. https://doi.org/10.1002/ijgo.14609\nBecker CM, Bokor A, Heikinheimo O, Horne A, Jansen F, Kiesel L, King K, Kvaskoff M, Nap A, Petersen K, Saridogan E, Tomassetti C, van Hanegem N, Vulliemoz N, Vermeulen N; ESHRE Endometriosis Guideline Group. ESHRE guideline: endometriosis. Hum Reprod Open. 2022;2022(2):hoac009. https://doi.org/10.1093/hropen/hoac009.\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(5):964–977. https://doi.org/10.1093/humrep/deu041\nAndres MP, Borrelli GM, Ribeiro J, Baracat EC, Abrão MS, Kho RM. Transvaginal ultrasound for the diagnosis of adenomyosis: systematic review and meta-analysis. J Minim Invasive Gynecol. 2018;25(2):257–264. https://doi.org/10.1016/j.jmig.2017.08.653\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(2):408–418.e3. https://doi.org/10.1016/j.jmig.2019.11.001\nGordts S, Brosens JJ, Fusi L, Benagiano G, Brosens I. Uterine adenomyosis: a need for uniform terminology and consensus classification. Reprod Biomed Online. 2008;17(2):244–248. https://doi.org/10.1016/s1472-6483(10)60201-5\nMatot R, Blickstein O, Leibner G, Bar-Peled U, Borovich A, Geron Y, Gilboa Y, Krissi H, Perlman S. Differences in the sonographic features of adenomyosis and concurrent endometriosis compared to isolated adenomyosis: a MUSA criteria analysis. J Ultrasound Med. 2025;44(6):1077–1084. https://doi.org/10.1002/jum.16667\nStewart EA, Cookson C, Gandolfo RA, Schulze-Rath R. Epidemiology of uterine fibroids: a systematic review. BJOG 2017;124:1501–1512. https://doi.org/10.1111/1471-0528.14640\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(6):1154–1161.e3. https://doi.org/10.1016/j.fertnstert.2018.06.031\nSmith D, Bolton G. Diagnosing adenomyosis using transvaginal ultrasound in current practice: a scoping review and service evaluation. Ultrasound. 2025. https://doi.org/10.1177/1742271X251338147\nMoawad G, Fruscalzo A, Youssef Y, Kheil M, Tawil T, Nehme J, Pirtea P, Guani B, Afaneh H, Ayoubi JM, Feki A. Adenomyosis: an updated review on diagnosis and classification. J Clin Med. 2023;12(14):4828. https://doi.org/10.3390/jcm12144828\nBiasioli A, Degano M, Restaino S, Bagolin M, Moro F, Ciccarone F, Testa AC, Greco P, Scambia G, Vizzielli G, Driul L, The Udine Hospital Endometriosis Group. Innovative ultrasound criteria for the diagnosis of adenomyosis and correlation with symptoms: a retrospective re-evaluation. Biomedicines. 2024;12(2):463. https://doi.org/10.3390/biomedicines12020463\nBazot M, Daraï E. Role of transvaginal sonography and magnetic resonance imaging in the diagnosis of uterine adenomyosis. Fertil Steril. 2018;109(3):389–397. https://doi.org/10.1016/j.fertnstert.2018.01.024\nSharma K, Bora MK, Venkatesh BP, Barman P, Roy SK, Jayagurunathan U, Sellamuthu E, Moidu F. Role of 3D ultrasound and doppler in differentiating clinically suspected cases of leiomyoma and adenomyosis of uterus. J Clin Diagn Res. 2015;9(4):QC08–12. https://doi.org/10.7860/JCDR/2015/12240.5846\nAcknowledgements\nThe authors thank Susan E. Hansen, MA, and Joanne Quinones, MD, FACOG for editorial assistance and manuscript formatting support.\nAuthor information\nAuthors and Affiliations\nContributions\nS.D did all the data collection and chart review. K.S did most of the data analysis. S.D and C.M and J.W wrote the manuscript. A.S and E.L were part of the study. All authors reviewed the manuscript.\nCorresponding author\nEthics declarations\nConflict of interest\nThe authors declare no competing interests.\nCollaborators\nNot applicable.\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\nDosunmu, S., Sarno, A., Lee, E. et al. Validation of the revised MUSA criteria for sonographic detection of adenomyosis. Abdom Radiol 51, 274–282 (2026). https://doi.org/10.1007/s00261-025-05039-y\nReceived:\nRevised:\nAccepted:\nPublished:\nVersion of record:\nIssue date:\nDOI: https://doi.org/10.1007/s00261-025-05039-y","source_license":"CC0","license_restricted":false}