Validation of the revised MUSA criteria for sonographic detection of adenomyosis

Objective(s) This study aims to assess the diagnostic accuracy of the revised Morphologic Uterus Sonographic Assessment (MUSA) criteria for adenomyosis.

Retrospective 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.

Reviewer 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%. Conclusion(s) The 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. Similar content being viewed by others Data availability No datasets were generated or analysed during the current study.

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The authors thank Susan E. Hansen, MA, and Joanne Quinones, MD, FACOG for editorial assistance and manuscript formatting support. Author information Authors and Affiliations Contributions S.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. Corresponding author Ethics declarations Conflict of interest The authors declare no competing interests. Collaborators Not applicable. Additional information Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions Springer 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. About this article Cite this article Dosunmu, 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 Received: Revised: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00261-025-05039-y