Evaluating transvaginal ultrasound for adenomyosis provides critical diagnostic clarity in modern gynaecological practice. Clinicians frequently rely on non-invasive imaging to identify myometrial changes accurately. Recently, research examined how direct and indirect sonographic features perform when compared to histopathology.

Direct Signs in Transvaginal Ultrasound for Adenomyosis

Direct sonographic features offer the most reliable diagnostic value. Specifically, echogenic subendometrial lines showed the highest balance between sensitivity and specificity in the cohort study. Therefore, clinicians should focus on these direct markers during routine pelvic scans. Consequently, identifying direct features helps confirm uterine pathology with greater confidence.

Role of Indirect Signs and Diagnostic Accuracy

Indirect ultrasound features demonstrate high specificity, but they exhibit limited sensitivity. Furthermore, adding indirect signs to direct sign models did not yield meaningful incremental benefits. However, indirect markers remain useful supportive indicators during clinical evaluation. Overall, combining direct signs achieved a diagnostic accuracy of nearly 79% in histologically confirmed cases.

Frequently Asked Questions

Q1: What is the primary benefit of transvaginal ultrasound for adenomyosis?

Transvaginal ultrasound offers a non-invasive, accessible method to identify key direct myometrial markers associated with adenomyosis.

Q2: How do direct and indirect ultrasound signs differ in performance?

Direct signs provide consistent diagnostic reliability, whereas indirect signs serve primarily as supportive evidence rather than definitive proof.

References

Morales C et al. Diagnostic accuracy of transvaginal ultrasound for adenomyosis using consensus-based direct and indirect sonographic signs: prospective cohort study. Ultrasound Obstet Gynecol. 2026 Aug 12. doi: 10.1002/uog.70315. PMID: 42584944.
van den Bosch T et al. Terms, definitions and measurements to describe the sonographic features of myometrium and myometrial lesions: Morphological Uterus Sonographic Assessment (MUSA) statement. Ultrasound Obstet Gynecol. 2015;46(3):284-298.