Adenomyosis Imaging Diagnosis

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

🎓 Want to practice? Do a case challenge with this pathway → (get a case, choose management step by step, scored).

Full pathway

1. [Decision] MUSA / MRI assessment
   Transvaginal ultrasound (MUSA) / MRI assessment? (Ectopic endometrium within the myometrium. TVUS (MUSA) direct features: myometrial cysts, hyperechoic islands, subendometrial lines/buds; indirect features: globular uterus, asymmetric thickening (>5 mm), fan-shaped shadowing, translesional vascularity, irregular/interrupted JZ. ≥1 direct feature is diagnostic. MRI for ultrasound-indeterminate cases.)
   • MUSA ≥1 direct feature, or MRI junctional zone (JZ) ≥12 mm → Diagnose adenomyosis · benign
   • JZ 8–12 mm or indirect features only (indeterminate) → Indeterminate (JZ 8–12 mm) · MRI characterization
   • Need to differentiate adenomyoma vs fibroid → Adenomyoma vs fibroid
2. [End] Diagnose adenomyosis · benign
   Diagnose adenomyosis (MUSA ≥1 direct feature or MRI JZ ≥12 mm): benign; small T2/T1 myometrial high-signal foci support it; individualized treatment by symptoms (dysmenorrhea/heavy menses/infertility) (medical/HIFU/UAE/surgery), no tumor follow-up needed.
3. [End] Indeterminate (JZ 8–12 mm) · MRI characterization
   JZ 8–12 mm or indirect features only: indeterminate zone, MRI for further characterization (JZ:myometrium ratio >40%, high-signal foci), follow up with symptoms; account for menstrual cycle/hormone-related JZ changes, do not rely on the threshold alone.
4. [End] Adenomyoma vs fibroid
   Adenomyoma vs fibroid: an adenomyoma has ill-defined borders, little mass effect, T2/T1 small cystic foci, no peripheral vessels; a fibroid has well-defined borders, often peripheral vessels. MRI differentiates accurately, affecting treatment choice (uterus-sparing vs excision).

Source guidelines & references

• Adenomyosis MRI (junctional zone ≥12 mm; Insights Imaging 2017)
• Adenomyosis ultrasound MUSA revised consensus · source ↗

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

Other pathways