Imaging Spectrum of Typical and Atypical Adenomyosis

Alice Brandão, Brunna C Oliveira, Oliveira BC, Ingrid A G Ferreira, Luciana G Matteoni-Athayde, Lucas Rios Torres, Luciana Camara Belém, Izabela Pires Franco, Akram M. Shaaban, Douglas Rogers, Luciana Pardini Chamié
Radiographics : a review publication of the Radiological Society of North America, Inc · 2025 · vol. 45(5) , pp. e240152 · doi:10.1148/rg.240152 · PMID:40310751
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⚙ AI-generated summary by claude@2026-06, 2026-06-09 ⓘ

This paper reviews the ultrasound and MRI imaging findings of typical and atypical adenomyosis, including focal, diffuse, adenomyomas, and pregnancy-related presentations, to aid in differential diagnosis.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-09 · read from full text ⓘ

This RadioGraphics article reviews the imaging spectrum of typical and atypical adenomyosis, focusing on endovaginal ultrasound and MRI with specific attention to junctional zone assessment and grading/severity frameworks. It describes characteristic imaging appearances of typical adenomyosis, outlines classification and characterization approaches, and discusses differential diagnoses. The paper also covers atypical variants including adenomyoma (including cystic adenomyoma), extrauterine adenomyomas, and polypoid adenomyoma, along with scenarios such as adenomyosis during pregnancy and the entity of malignant transformation with attention to endometrial adenocarcinoma and low-grade endometrial stromal sarcoma as differentials. It does not present new original study data but instead synthesizes imaging concepts and differential considerations; this paper is centrally about adenomyosis imaging features. This paper is centrally about adenomyosis — it provides an imaging-based spectrum of typical and atypical adenomyosis.

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Abstract

Adenomyosis, characterized by heterotopic endometrial tissue within the myometrium, is a common yet poorly understood condition affecting patients of childbearing age. Although typical features of adenomyosis are extensively discussed in the literature, there is no consensus on its imaging classification. The Morphological Uterus Sonographic Assessment (MUSA) consensus statement is a valuable tool for identifying and describing typical adenomyosis imaging features at US. However, for MRI, there is still no standardized consensus for descriptors and subtypes. The diverse atypical manifestations of adenomyosis are a diagnostic challenge. Familiarity with these manifestations is essential for accurate diagnosis, avoiding misdiagnosis, and ensuring optimal clinical management. The authors examine the imaging appearances of typical and atypical adenomyosis at US and MRI, encompassing focal adenomyosis, diffuse adenomyosis, adenomyomas (solid and cystic types), polypoid adenomyomas, adenomyosis during pregnancy, and malignant transformation. The discussion includes clinical, surgical, and pathologic aspects in the differential diagnosis, with consideration of uterine contractions, deep endometriosis with myometrial infiltration, leiomyomas, and accessory cavitated uterine masses. Practical tips are provided to assist radiologists in distinguishing adenomyosis from other conditions. ©RSNA, 2025 Supplemental material is available for this article.
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Abstract

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Introduction

Overview of Imaging-based Diagnosis of Adenomyosis Endovaginal US Magnetic Resonance Imaging Assessment of JZ Assessment of Severity of Adenomyosis Typical Adenomyosis Classification and Characterization Differential Diagnosis Atypical Adenomyosis Adenomyoma Cystic Adenomyoma Differential Diagnosis Extrauterine Adenomyomas Polypoid Adenomyoma Adenomyosis during Pregnancy Malignant Transformation of Adenomyosis Endometrial Adenocarcinoma Low-grade Endometrial Stromal Sarcoma

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Information & Authors Information Published In Abbreviations - ACUM - accessory cavitated uterine mass - JZ - junctional zone - MUSA - Morphologic Uterus Sonographic Assessment Copyright History Authors Author Contributions Disclosures of conflicts of interest.— Metrics & Citations Metrics Article Usage Altmetrics Citations Export citation Select the format you want to export the citation of this publication. Cited by View Options To read the full-text, please use one of the options below to sign in or purchase access. RSNA members have free access to all RadioGraphics content. However, complimentary journal-based CME activities are only included for members with the Standard or Full Access packages. RSNA Journals participate in the World Health Organization's Research4Life program and the online versions of the journals are either freely available or are available with low-cost access to not-for-profit institutions in eligible countries. Login options Check if you have access through your login credentials or your institution to get full access on this article. Purchase Options Subscribe and get full access to this article. Recommend this journal to your librarian To read the full-text, please use one of the options below to sign in or purchase access. RSNA members have free access to all RadioGraphics content. However, complimentary journal-based CME activities are only included for members with the Standard or Full Access packages. RSNA Journals participate in the World Health Organization's Research4Life program and the online versions of the journals are either freely available or are available with low-cost access to not-for-profit institutions in eligible countries. Recommend to a librarian Recommend this journal to your librarian Redeem Voucher Access tokens allow you to activate and access content online. If you have been issued an access token, please enter it here and click 'Submit':

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Outcome instruments

MUSA

Condition tags

endometriosisadenomyosis

MeSH descriptors

Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis

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