Ultrasound Diagnosis of Adenomyosis: A Literature Review and Clinical Cases

Е. А. Борисова, M. N. Bulanov, Т. А. Макаренко
In: Ultrasound & Functional Diagnostics · 2026 · vol. 32(3) , pp. 62–79 · doi:10.24835/1607-0771-382 · W7216523675
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This literature review and clinical case analysis evaluates the utility of ultrasound for adenomyosis diagnosis, highlighting MUSA consensus criteria and variable diagnostic performance metrics across studies.

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This literature review examines the diagnostic capabilities of ultrasound for adenomyosis, synthesizing forty-five years of published research and clinical observations. The authors highlight that while numerous criteria exist, the Morphological Uterus Sonographic Assessment consensus provides the most practical direct and indirect signs for diagnosis. Reported diagnostic accuracy varies significantly across studies, with sensitivity ranging from 72 to 91 percent and specificity between 49 and 90 percent, indicating considerable variability in performance metrics. Although some evidence suggests a correlation between sonographic features and clinical severity, this relationship is not universally accepted by all researchers. This paper is centrally about adenomyosis — specifically focusing on the development, standardization, and diagnostic accuracy of transvaginal ultrasound criteria for identifying the condition.

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Abstract

This review addresses the utility of ultrasound in the diagnosis of adenomyosis. Over the past 45 years, the topic has been extensively covered in the literature. To date, at least 20 ultrasound criteria for adenomyosis have been proposed by various research groups. Currently, the most clinically relevant are the direct and indirect ultrasound features of adenomyosis as delineated by the MUSA (Morphological Uterus Sonographic Assessment) international consensus. Reported diagnostic value for ultrasound in adenomyosis detection vary across studies: sensitivity ranges from 72 % to 91 %, specificity from 49 % to 90 %, positive predictive value (PPV) from 72 % to 82 %, negative predictive value (NPV) from 49 % to 80 %, and accuracy from 56 % to 63 %. A correlation between ultrasound findings and clinical manifestations of adenomyosis has been described (including an association between the severity of symptoms and the number of detected imaging features), although this relationship remains a subject of debate among experts.
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Ультразвуковая диагностика аденомиоза. Обзор литературы и собственные клинические наблюдения https://doi.org/10.24835/1607-0771-382 Аннотация Обзор посвящен возможностям ультразвуковой диагностики аденомиоза. В течение 45 лет было опубликовано очень большое количество печатных работ, посвященных этому вопросу. К настоящему времени различными авторами предложено не менее 20 ультразвуковых критериев аденомиоза. Наибольшее практическое значение в настоящее время имеют прямые и косвенные ультразвуковые признаки аденомиоза, предложенные международным консенсусом MUSA. Диагностическая ценность ультразвукового исследования при диагностике аденомиоза, по данным различных авторов, составляет: чувствительность 72–91%; специфичность 49–90%; прогностическая ценность положительного результата 72–82%; прогностическая ценность отрицательного результата 49–80%; точность 56–63%. Наблюдается корелляция между ультразвуковыми признаками аденомиоза и клиническими проявлениями заболевания (в том числе между тяжестью клинических проявлений и количеством ультразвуковых признаков), хотя эту точку зрения поддерживают не все авторы. Об авторах Е. А. БорисоваРоссия Борисова Елена Анатольевна – канд. мед. наук, ассистент кафедры оперативной гинекологии Института последипломного образования ФГБОУ ВО “Красноярский государственный медицинский университет имени профессора В.Ф. Войно-Ясенецкого” Минздрава России; врач ультразвуковой диагностики ООО “МедикоПрофи” – “Лечебно-диагностическая клиника Борисовых”, Красноярск http://orcid.org/0000-0002-4667-6298 E-mail: [email protected] М. Н. Буланов Россия Буланов Михаил Николаевич – доктор мед. наук, заведующий отделением ультразвуковой диагностики ГБУЗ ВО “Областная клиническая больница”, Владимир; профессор кафедры внутренних болезней Института медицинского образования ФГБОУ ВО “Новгородский государственный университет имени Ярослава Мудрого”, Великий Новгород https://orcid.org/0000-0001-8295-768X Т. А. Макаренко Россия Макаренко Татьяна Александровна – доктор мед. наук, профессор, заведующая кафедрой оперативной гинекологии Института последипломного образования ФГБОУ ВО “Красноярский государственный медицинский университет имени профессора В.Ф. Войно-Ясенецкого” Минздрава России, Красноярск https://orcid.org/0000-0002-2899-8103 Список литературы 1. Давыдов А.И., Таирова М.Б., Михалева Л.М., Кавиладзе М.Г., Чилова Р.А. Аденомиоз. Что изменилось с появлением МКБ-11? Вопросы гинекологии, акушерства и перинатологии. 2021; 20 (2): 117–124. https://doi.org/10.20953/1726-1678-2021-2-117-124 2. 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Internal and external adenomyosis phenotypes: ultrasound features and association with clinical outcomes. Hum. Reprod. 2024: deae105. https://doi.org/10.1093/humrep/deae105 56. Vannuccini S., Meleca C., Toscano F. et al. Adenomyosis diagnosis among adolescents and young women with dysmenorrhoea and heavy menstrual bleeding. Reprod. Biomed. Online. 2024; 48 (5): 103768. https://doi.org/10.1016/j.rbmo.2023.103768 57. Matot R., Blickstein O., Leibner G. et al. 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 Рецензия Для цитирования: Борисова Е.А., Буланов М.Н., Макаренко Т.А. Ультразвуковая диагностика аденомиоза. Обзор литературы и собственные клинические наблюдения. Ультразвуковая и функциональная диагностика. 2026;32(3):62-79. https://doi.org/10.24835/1607-0771-382 For citation: Borisova E.A., Bulanov M.N., Makarenko T.A. Ultrasound Diagnosis of Adenomyosis: A Literature Review and Clinical Cases. Ultrasound & Functional Diagnostics. 2026;32(3):62-79. (In Russ.) https://doi.org/10.24835/1607-0771-382 JATS XML

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