Adenomyosis: A Sonographic Diagnosis

Ryan K. Cunningham, Mindy M Horrow, Ryan J Smith, Joseph Springer, Joseph W. Springer
Radiographics : a review publication of the Radiological Society of North America, Inc · 2018 · vol. 38(5) , pp. 1576–1589 · doi:10.1148/rg.2018180080 · PMID:30207945 · W2892260666
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

Transvaginal ultrasound is the primary imaging modality for diagnosing adenomyosis by identifying characteristic sonographic findings related to ectopic endometrial glands, muscular hyperplasia, and increased vascularity within the myometrium.

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Abstract

Adenomyosis is a common benign uterine condition and a frequent cause of pelvic pain in premenopausal women. Transvaginal US is now considered the primary imaging modality for the diagnosis of adenomyosis, and thus radiologists should be familiar with its sonographic appearance. US findings can be divided into three categories, which parallel the histology of adenomyosis: (a) ectopic endometrial glands and stroma, (b) muscular hyperplasia/hypertrophy, and (c) increased vascularity. Ectopic endometrial glands manifest as echogenic nodules and striations, radiating from the endometrium into the myometrium. When the glands contain fluid, myometrial cysts and fluid-filled striations may be visible at US. Muscular hyperplasia and hypertrophy cause focal or diffuse myometrial thickening and globular uterine enlargement, often with thin “venetian blind” shadows. The combination of these findings results in a heterogeneous myometrium, with blurring of the endometrial border. Adenomyosis increases uterine vascularity, depicted as a pattern of penetrating vessels at color Doppler US. Other US techniques that are helpful in the diagnosis of adenomyosis include obtaining cine clips and coronal reformatted images, both of which can survey the entire endometrial-myometrial border, and performing saline-infusion sonohysterography, during which ectopic glands frequently fill with either air or fluid. While most cases of adenomyosis develop spontaneously, there are specific inciting causes that include tamoxifen use, postendometrial ablation syndrome, and deep-infiltrating endometriosis. Mimics of adenomyosis include leiomyomas, uterine contractions, neoplasms, and vascular malformations. This article reviews the pathophysiology of adenomyosis and correlates it with the US findings, highlights specific causes of adenomyosis, and describes how to distinguish this common diagnosis from a variety of mimics. Online supplemental material is available for this article. ©RSNA, 2018

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Condition tags

endometriosisadenomyosis

MeSH descriptors

Adenomyosis Ultrasonography Adenomyosis Adenomyosis Adenomyosis Diagnosis, Differential Female Humans Leiomyoma Leiomyoma Ultrasonography Uterine Neoplasms Uterine Neoplasms

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.

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Cited by (50)

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