Imaging & Diagnosis (MRI, Ultrasound)
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Understand how MRI and ultrasound identify adenomyosis, what to expect before and during scans, how findings are interpreted, and how results shape your treatment options.
Overview
MRI and ultrasound are the primary tools for recognizing adenomyosis and clarifying whether disease is diffuse or focal. Expert transvaginal ultrasound is often first‑line, using MUSA criteria to look for a globular uterus, heterogeneous myometrium, fan‑shaped shadowing, and small myometrial cysts. MRI adds clarity when ultrasound is inconclusive, when fibroids are also present, or before planning uterus‑sparing surgery. It highlights junctional zone changes and the extent and location of involvement, which helps distinguish adenomyosis from look‑alike conditions and informs treatment choices.
Scans are safe and radiation‑free. A pelvic MRI typically takes 30–45 minutes; contrast is seldom required for adenomyosis. Scheduling in the early to mid‑cycle can reduce false positives from normal junctional zone thickening, and antispasmodic medication may be used to limit motion. Results guide next steps—from hormonal options to conservative surgery or hysterectomy—and can shape fertility planning. For subtype‑specific guidance, see Diffuse Adenomyosis and Focal Adenomyosis; for care decisions and family‑building, see Surgical Options and Fertility Considerations. If coexisting endometriosis is suspected, complementary details are covered in MRI and Ultrasound.
Which is better for diagnosing adenomyosis—ultrasound or MRI?
Transvaginal ultrasound by an experienced sonographer is often sufficient and is the usual first step. MRI is helpful when ultrasound is equivocal, when fibroids obscure the view, or for detailed mapping before treatment, offering higher contrast resolution to differentiate diffuse from focal disease.
How should I prepare for imaging, and does timing within the cycle matter?
For transvaginal ultrasound, an empty bladder improves images; the scan takes only minutes. MRI can be scheduled any time, but early to mid‑cycle may reduce overestimation from normal junctional zone thickening; avoid heavy bleeding days if possible for comfort and image quality.
Can adenomyosis be missed on imaging?
Yes. Mild or patchy disease and operator variability can lead to under‑detection, especially on ultrasound. A normal or borderline study doesn’t exclude adenomyosis; clinicians integrate symptoms, exam, and imaging, and may still offer treatment or repeat imaging when suspicion remains high.
Will I need contrast for my MRI, and is it safe?
Gadolinium contrast is usually unnecessary for adenomyosis but may be used if other conditions are suspected. It is generally safe with normal kidney function; pregnancy is a precaution, and breastfeeding can continue after contrast based on current radiology guidelines.
How do imaging results change treatment and fertility planning?
Findings such as depth and extent of involvement help tailor options—from hormonal therapy or an LNG‑IUD to conservative adenomyomectomy or hysterectomy. Imaging also informs expectations for pain control and conception, guiding decisions outlined in Surgical Options and Fertility Considerations.
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