Adenomyosis from a Third Perspective: What is the Influence of 3D Ultrasound?

Genital / Reproductive system female, Ultrasound, Education, Education and training Authors: G. C. V. Lauar, M. C. V. Lauar, A. G. Afonso, S. B. Maksoud, P. C. Silva Júnior, A. L. S. Marques, C. C. Barbisan DOI: 10.26044/ecr2025/C-17843 Learning objectives The aim of this study is to highlight the importance of adopting 3D ultrasound for the diagnosis of adenomyosis. Based on the most recent literature and our ultrasound experience, we will review the basic pathological concepts of adenomyosis, compare diagnostic methods, and discuss how to perform 3D ultrasound, as well as which findings are crucial for recognising this highly prevalent condition.

Adenomyosis is a benign, oestrogen-dependent condition, characterised by the invasion of endometrial tissue into the myometrium (1), resulting in the disruption of the junctional zone. Its main symptoms include pain, menorrhagia, metrorrhagia, dysmenorrhea, and dyspareunia (2). While the exact cause of adenomyosis is unknown, the prevailing theory is that the endometrial glands directly invade the myometrium (2).Two main theories seek to explain its pathogenesis: the invagination theory and the metaplasia theory. The first is based on the tissue injury and repair hypothesis, which suggests that... Findings and procedure details Advances in transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI) have aided in the non-invasive diagnosis of adenomyosis in younger women (4,5). TVUS is the initial examination in the investigation of patients with dysmenorrhoea and abnormal uterine bleeding, as it offers high sensitivity and specificity (similar to MRI) (2, 4), reported at 72% and 81%, respectively, according to Hiroshi Kobayashi (5).Three-dimensional (3D) transvaginal ultrasound (TVS) has been shown to enhance diagnostic accuracy for adenomyosis by providing a more detailed visualisation of changes in the junctional...

Given the efficacy, safety, widespread availability, and lower cost compared to MRI, transvaginal ultrasound should be regarded as the first-line imaging modality for diagnosing adenomyosis (2). The integration of 3D imaging can enhance diagnostic accuracy and is recommended when possible (6). Despite this, limitations exist, such as the need for appropriate transducers and technical expertise. Therefore, studies focusing on the technical aspects and interpretation of images are necessary (6). Personal information and conflict of interest G. C. V. Lauar: Nothing to disclose M. C. V. Lauar: Nothing to disclose A. G. Afonso: Nothing to disclose S. B. Maksoud: Nothing to disclose P. C. Silva Júnior: Nothing to disclose A. L. S. Marques: Nothing to disclose C. C. Barbisan: Nothing to disclose

1- Harmsen, M. J., et al. "Consensus on revised definitions of Morphological Uterus Sonographic Assessment (MUSA) features of adenomyosis: results of modified Delphi procedure." Ultrasound in Obstetrics & Gynecology 60.1 (2022): 118-131.2- Cunningham, Ryan K., et al. "Adenomyosis: a sonographic diagnosis." Radiographics 38.5 (2018): 1576-1589.3- Guo, Sun-Wei. "Cracking the enigma of adenomyosis: an update on its pathogenesis and pathophysiology." Reproduction 164.5 (2022): R101-R121.4- Moawad, Gaby, et al. "Adenomyosis: an updated review on diagnosis and classification." Journal of clinical medicine 12.14 (2023): 4828.5- Kobayashi, Hiroshi, and...