The nonsurgical diagnosis of adenomyosis

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Abstract
Objective: To survey the nonsurgical diagnostic techniques for distinguishing adenomyosis, and to determine whether one technique offers diagnostic advantages. Data Sources: We conducted a thorough search of the MEDLINE data base and identified English-language papers on adenomyosis published during the last 28 years. Reference lists of retrieved articles were also examined for additional source documents. Methods of Study Selection: We reviewed 238 articles. Papers on nonsurgical diagnostic techniques published in peer-reviewed journals were selected for inclusion. Data Extraction and Synthesis: We determined nonsurgical diagnostic techniques for distinguishing adenomyosis to be hysterosalpingography, abdominal ultrasound, transvaginal sonography, and magnetic resonance imaging (MRI). Studies were divided into these four categories, reviewed, and summarized accordingly. Recent reports suggest that noninvasive modalities, eg, transvaginal sonography and MRI, have made possible the nonsurgical diagnosis of adenomyosis. Conclusion: Because of its widespread availability and patient tolerance, transvaginal sonography remains the primary screening modality for imaging the female pelvis. However, for cases in which sonography cannot detect adenomyosis, MRI provides a viable alternative and should be the definitive diagnostic modality of choice.

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