Diagnostic Accuracy of Transvaginal Ultrasound in Adenomyosis Taking MRI as a Gold Standard

Afshan Shaikh, Imrana Masroor, Aysha Masood, Shaista Afzal Saeed
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP · 2023 · vol. 33(10) , pp. 1118–1123 · doi:10.29271/jcpsp.2023.10.1118 · PMID:37804016 · W4387420609
article OA: diamond CC0 ⤵ 5 in-corpus citations
🔓 Open OA copy View on OpenAlex View on PubMed View at publisher
⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This study found that transvaginal ultrasound has high specificity and positive predictive value for adenomyosis diagnosis, with combined features of bulky uterus, altered echotexture, and streaky myometrium showing the best accuracy compared to MRI.

One-sentence paraphrase of the abstract; not a substitute for reading it. No clinical advice. How this works

⚙ AI-generated deep summary by claude@2026-06, 2026-06-09 ⓘ

This cross-sectional diagnostic accuracy study evaluated transvaginal ultrasound in 208 symptomatic women (menstrual-cycle related symptoms or infertility work-up) by comparing specific ultrasound parameters against pelvic MRI as the gold standard, with all scans interpreted by senior radiologists/sonographers. Overall ultrasound showed high specificity (96.15%) and PPV (98.31%) but lower sensitivity (74.36%) and low NPV (55.56), indicating missed cases even when MRI was positive; the paper reports that MRI-equivocal cases and technically unevaluable MRIs were excluded. The most sensitive dual combination was a bulky uterus with altered myometrial echotexture (sensitivity 72.97%, specificity 95.83%), and the best triple combination included bulky uterus, altered echotexture, and streaky myometrium (sensitivity 71.85%, specificity 95.46%). This paper is centrally about endometriosis and/or adenomyosis — it is specifically about adenomyosis diagnostic performance of transvaginal ultrasound using MRI as the reference standard.

Read from the paper's body, not the abstract. Not a substitute for reading the paper. No clinical advice. How this works

Abstract

OBJECTIVE: To evaluate the accuracy of transvaginal ultrasound in the diagnosis of adenomyosis using MRI as the gold standard, and to characterise the most commonly seen and accurate ultrasonographic features and their combination. STUDY DESIGN: Cross-sectional, descriptive study. Place and Duration of the Study: Department of Radiology, The Aga Khan University Hospital, Karachi, from January 2018 to July 2021. METHODOLOGY: Transvaginal ultrasound examination was performed on patients (n = 208) who presented with symptoms related to menstrual cycles and pelvic abnormalities. Additionally, patients who sought infertility evaluation were also included in the study. The findings from the ultrasound examinations were assessed and tabulated alongside the results of the MRI scans. All examinations were conducted by senior radiologists / sonographers. The sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively) of ultrasound features were calculated individually and in combination, taking MRI as the gold standard. To enhance the accuracy of ultrasound findings, various variables were combined, and their sensitivities and specificities were calculated. RESULTS: Overall, transvaginal ultrasound had a high specificity of 96.15% (95% CI: 85.67 - 99.33), a relatively low sensitivity of 74.36% (95% CI: 66.63 - 80.85), PPV of 98.31 (95% CI: 93.40 - 99.70) and NPV of 55.56 (95% CI: 44.73 - 65.90). The most sensitive dual variable used was a bulky uterus combined with altered myometrial echotexture, with a sensitivity of 72.97% (95% CI: 64.95 - 79.78) and specificity of 95.83% (95% CI: 84.57-99.27). The best combined triple variable was a bulky uterus with altered echotexture and streaky myometrium, with a sensitivity of 71.85% (95% CI: 63.35 - 79.10) and a specificity of 95.46% (95% CI: 83.30 - 99.21). CONCLUSION: Transvaginal ultrasound features can identify adenomyosis characteristics in most of the patients. This could reduce the number of pelvic MRIs performed for the detection of adenomyosis. KEY WORDS: Adenomyosis, Diagnosis, Magnetic resonance imaging, Bulky uterus, Altered myometrial, Echotexture, Ultrasound.

My notes (saved in your browser only)

Condition tags

endometriosisadenomyosisinfertility

MeSH descriptors

Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Endometriosis Endometriosis Endometriosis Endometriosis

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (18)

Cited by (5)

Source provenance

europepmc
last seen: 2026-06-11T06:19:48.454388+00:00
openalex
last seen: 2026-06-10T17:14:06.276822+00:00
pubmed
last seen: 2026-06-04T00:33:28.295845+00:00
License: CC0 · commercial use OK