department radiology

uterine cavity

endometrial thickness

adnexal masses

transvaginal ultrasound

transvaginal sonography

Ultrasound in obstetrics & gynecology

In 2015, the international Morphological Uterus Sonographic Assessment (MUSA) group published a consensus on which terminology to use when describing myometrial lesions seen on ultrasonography1. The use of MUSA terminology to describe ultrasound images of fibroids, including their location according to the International Federation of Gynecology and Obstetrics (FIGO), is relatively straightforward to implement2, 3. However, even though the MUSA consensus statement suggests which terms should be used to describe ultrasound images of adenomyosis, it does not provide guidelines on how to classify morphological types or the extent of adenomyosis1. We propose a uniform reporting system for ultrasound findings of adenomyosis. The opinion presented herein is based on a thorough discussion among all authors, including a Delphi procedure (Appendix S1). Images and videos of cases typical of the different morphological variations of adenomyosis were used in the debates. The gold standard for the diagnosis of adenomyosis is histological examination of a hysterectomy specimen. Because only a small, selected group of women undergo hysterectomy, an accurate estimation of the prevalence of the disease cannot be established4. The introduction of imaging techniques such as transvaginal sonography and magnetic resonance imaging (MRI) has allowed non-invasive diagnosis of adenomyosis5-8. Ultrasound imaging is widely available in an office setting, is relatively inexpensive, requires no preparation, has no contraindications and is relatively accurate in expert hands, making it the imaging modality of choice in gynecology7. Although adenomyosis is usually diagnosed in women between 40 and 60 years of age, it is also described in younger women, in whom any surgery performed on the uterus might adversely affect child-bearing9. The treatment of choice for adenomyosis is primarily hormonal (e.g. levonorgestrel intrauterine device; oral progestins)10. Patient management is often based on ultrasound diagnosis alone. This highlights the impor...

Sonographic classification and reporting system for diagnosing adenomyosis