Imaging features of adenomyosis

This review focuses on non-invasive imaging techniques that have proven useful in diagnosing adenomyosis, including hysterosalpingography, transabdominal and endovaginal ultrasound, as well as magnetic resonance imaging. An understanding of the histopathological features of this disease is crucial when attempting to interpret the associated imaging findings. The muscular hyperplasia accompanying the heterotopic endometrial tissue actually produces the typical gross appearance of adenomyosis and corresponds to areas of decreased echogenicity or signal intensity on ultrasound and magnetic resonance imaging respectively. The heterotopic endometrial tissue also contributes to the imaging appearance of adenomyosis, and with the advent of high resolution imaging techniques, these changes are being detected with increasing frequency, including the presence of myometrial nodules, linear striation, poor definition and nodularity of the endo-myometrial junction, pseudowidening of the endometrium, and myometrial cysts or haemorrhagic foci. The purpose of this review is to (i) present the spectrum of imaging findings of adenomyosis, (ii) illustrate potential pitfalls in diagnosis and (iii) review the accuracy and role of currently available noninvasive imaging techniques.