Diagnostic Accuracy of Ultrasonography in Diagnosing Uterine Adenomyosis Using Magnetic Resonance Imaging as the Gold Standard

In: Biological and Clinical Sciences Research Journal · 2025 · vol. 6(5) , pp. 464–467 · doi:10.54112/bcsrj.v6i5.2277 · W7161249484
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This study evaluated ultrasonography's diagnostic accuracy for uterine adenomyosis against MRI, finding 70.70% accuracy with 69.12% sensitivity and 73.42% specificity.

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This study evaluated the diagnostic accuracy of transvaginal ultrasonography for uterine adenomyosis by comparing it against magnetic resonance imaging as the gold standard in a cohort of 215 women aged 18 to 45. The results indicated that ultrasound demonstrated a sensitivity of 69.12%, a specificity of 73.42%, and an overall diagnostic accuracy of 70.70% in identifying the condition. While MRI identified positive cases in 63.3% of participants, ultrasound detected them in 53.5%, highlighting moderate performance metrics for the less invasive modality. This paper is centrally about adenomyosis — specifically assessing the comparative diagnostic utility of ultrasound versus MRI for its detection.

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Abstract

Uterine adenomyosis is a common benign gynecological disorder that may present with dysmenorrhea, abnormal uterine bleeding, and chronic pelvic pain. Magnetic resonance imaging is considered a reliable reference standard, while ultrasonography remains a widely available first-line diagnostic modality. Objective: To determine the diagnostic accuracy of ultrasonography in diagnosing of uterine adenomyosis keeping magnetic resonance imaging as gold standard. Methods: This study was conducted on 215 females aged 18 to 45 years with suspected adenomyosis. Patients who had recent uterine surgery, uterine fibroids, pelvic inflammatory disease, and tubal pathology were excluded from the study. All patients underwent transvaginal ultrasound, which was followed by pelvic MRI. Diagnostic accuracy including sensitivity, specificity, positive predictive value, and negative predictive value, were calculated using a 2×2 contingency table, keeping the MRI as gold standard. SPSS 25 was used for analysis. Stratification was performed using chi square test, keeping significance level at 5%. Results: The mean age of 215 patients in this study was 30.17±7.84 years and their mean body mass index was 26.86±2.65 kg/m2. MRI showed positive adenomyosis in 136 patients (63.3%), which ultrasound was positive for adenomyosis in 115 (53.5%) patients. Ultrasonography exhibited sensitivity of 69.12%, specificity 73.42%, positive predictive value of 81.74%, negative predictive value 58.00%, and diagnostic accuracy 70.70%. Conclusion: The diagnostic accuracy of ultrasonography in diagnosing uterine adenomyosis keeping magnetic resonance imaging as gold standard was 70.70%, with sensitivity 69.12% and specificity 73.42%.
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Diagnostic Accuracy of Ultrasonography in Diagnosing Uterine Adenomyosis Using Magnetic Resonance Imaging as the Gold Standard DOI: https://doi.org/10.54112/bcsrj.v6i5.2277Keywords: Adenomyosis; Diagnostic accuracy; Magnetic resonance imaging; Transvaginal ultrasound; Uterine diseases.Abstract Uterine adenomyosis is a common benign gynecological disorder that may present with dysmenorrhea, abnormal uterine bleeding, and chronic pelvic pain. Magnetic resonance imaging is considered a reliable reference standard, while ultrasonography remains a widely available first-line diagnostic modality. Objective: To determine the diagnostic accuracy of ultrasonography in diagnosing of uterine adenomyosis keeping magnetic resonance imaging as gold standard. Methods: This study was conducted on 215 females aged 18 to 45 years with suspected adenomyosis. Patients who had recent uterine surgery, uterine fibroids, pelvic inflammatory disease, and tubal pathology were excluded from the study. All patients underwent transvaginal ultrasound, which was followed by pelvic MRI. Diagnostic accuracy including sensitivity, specificity, positive predictive value, and negative predictive value, were calculated using a 2×2 contingency table, keeping the MRI as gold standard. SPSS 25 was used for analysis. Stratification was performed using chi square test, keeping significance level at 5%. Results: The mean age of 215 patients in this study was 30.17±7.84 years and their mean body mass index was 26.86±2.65 kg/m2. MRI showed positive adenomyosis in 136 patients (63.3%), which ultrasound was positive for adenomyosis in 115 (53.5%) patients. Ultrasonography exhibited sensitivity of 69.12%, specificity 73.42%, positive predictive value of 81.74%, negative predictive value 58.00%, and diagnostic accuracy 70.70%. Conclusion: The diagnostic accuracy of ultrasonography in diagnosing uterine adenomyosis keeping magnetic resonance imaging as gold standard was 70.70%, with sensitivity 69.12% and specificity 73.42%. Downloads References 1. Moustafa BE, Hamed A, Moustafa AM. Recognizing the spectrum of sonographic presentations of adenomyosis in the peri-menopausal women underwent hysterectomy. Scientific Journal of Medical Scholar. 2021;2021(2):43-50. DOI: https://doi.org/10.55675/sjms.v2021i2.95 2. Harmsen MJ, Trommelen LM, de Leeuw RA, Tellum T, Juffermans LJM, Griffioen AW, et al. Uterine junctional zone and adenomyosis: comparison of MRI, transvaginal ultrasound and histology. Ultrasound Obstet Gynecol. 2023;62(1):42-60. DOI: https://doi.org/10.1002/uog.26117 3. Chapron C, Vannuccini S, Santulli P, Abrão MS, Carmona F, Fraser IS, et al. Diagnosing adenomyosis: an integrated clinical and imaging approach. Hum Reprod Update. 2020;26(3):392-411. DOI: https://doi.org/10.1093/humupd/dmz049 4. Bourdon M, Santulli P, Marcellin L, Maignien C, Maitrot-Mantelet L, Bordonne C, et al. Adenomyosis: an update regarding its diagnosis and clinical features. J Gynecol Obstet Hum Reprod. 2021;50(10):102228. DOI: https://doi.org/10.1016/j.jogoh.2021.102228 5. Choi EJ, Cho SB, Lee SR, Lim YM, Jeong K, Moon HS, et al. Comorbidity of gynecological and non-gynecological diseases with adenomyosis and endometriosis. Obstet Gynecol Sci. 2017;60(6):579-586. DOI: https://doi.org/10.5468/ogs.2017.60.6.579 6. Yamaguchi M, Yoshihara K, Suda K, Nakaoka H, Yachida N, Ueda H, et al. Three-dimensional understanding of the morphological complexity of the human uterine endometrium. iScience. 2021;24(4):102258. DOI: https://doi.org/10.1016/j.isci.2021.102258 7. Champaneria R, Abedin P, Daniels J, Balogun M, Khan KS. Ultrasound scan and magnetic resonance imaging for the diagnosis of adenomyosis: systematic review comparing test accuracy. Acta Obstet Gynecol Scand. 2010;89(11):1374-1384. DOI: https://doi.org/10.3109/00016349.2010.512061 8. Chapron C, Tosti C, Marcellin L, Bourdon M, Lafay-Pillet MC, Millischer AE, et al. Relationship between the magnetic resonance imaging appearance of adenomyosis and endometriosis phenotypes. Hum Reprod. 2017;32(7):1393-1401. DOI: https://doi.org/10.1093/humrep/dex088 9. Sam M, Raubenheimer M, Manolea F, Aguilar H, Mathew RP, Patel VH, et al. Accuracy of findings in the diagnosis of uterine adenomyosis on ultrasound. Abdom Radiol (NY). 2020;45(3):842-850. DOI: https://doi.org/10.1007/s00261-019-02231-9 10. Tariq M, Anwar J, Amin N, Gul B, Niaz A, Nawaz KH. Diagnostic accuracy of ultrasound and MRI for diagnosis of adenomyosis taking histopathology as gold standard. Pak Armed Forces Med J. 2022;72(Suppl 2):S346-S349. DOI: https://doi.org/10.51253/pafmj.v72iSUPPL-2.8064 11. Gallo R, Kamberaj L, Baroni A, De Cicco Nardone A, Scambia G, Masciullo V. Advances in non-invasive diagnosis of uterine adenomyosis: a narrative review. Gynecol Pelvic Med. 2025;8:13. DOI: https://doi.org/10.21037/gpm-24-52 12. Shaikh A, Masroor I, Masood A, Saeed SA. Diagnostic accuracy of transvaginal ultrasound in adenomyosis taking MRI as a gold standard. J Coll Physicians Surg Pak. 2023;33(10):1118-1123. DOI: https://doi.org/10.29271/jcpsp.2023.10.1118 13. Anjum A, Umbreen S, Nadeem MF, Noureen F, Asim F, Anwar S. Sonography and magnetic resonance imaging for the diagnosis of adenomyosis: comparison with histopathology. J Islamabad Med Dental Coll. 2024;13(4):638-645. DOI: https://doi.org/10.35787/jimdc.v13i4.1030 14. Maudot C, Vernet T, Debras E, Fernandez H, Capmas P. Diagnostic accuracy study of sonography in adenomyosis: a study of current practice. J Gynecol Obstet Hum Reprod. 2023;52(7):102604. DOI: https://doi.org/10.1016/j.jogoh.2023.102604 15. Rohini A, Nambiar J, Hebbar S. Diagnostic accuracy of ultrasound in the diagnosis of adenomyosis. J South Asian Feder Obst Gynaecol. 2024;16(6):641-643. DOI: https://doi.org/10.5005/jp-journals-10006-2547 Downloads Published How to Cite License Copyright (c) 2025 Sara Islam, Nadeem Ullah This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

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adenomyosischronic_pelvic_paindysmenorrhea

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