The Role of Modern Ultrasonography and Elastography Techniques in the Diagnosis of Adenomyosis

Resume. Adenomyosis is a common benign uterine disorder that causes heavy menstrual bleeding, dysmenorrhea, chronic pelvic pain and infertility, yet for decades it was confirmed only after hysterectomy. The aim of this review was to evaluate the place of modern transvaginal ultrasonography (two- and three-dimensional imaging, Doppler, the revised MUSA criteria) and ultrasound elastography in the non-invasive diagnosis of adenomyosis, in comparison with magnetic resonance imaging (MRI). Systematic reviews, meta-analyses and histology-validated diagnostic accuracy studies published in 2010–2025 were analysed. Pooled data show that transvaginal ultrasound reaches a sensitivity of 72–84% and a specificity of 64–81%, comparable to MRI (sensitivity 69–77%, specificity 80–89%). Three-dimensional assessment of the junctional zone increases sensitivity to 89–91%. Elastography adds an objective measure of tissue stiffness: pooled sensitivity is 87.2% and specificity 98.0%, and strain-ratio and shear-wave thresholds help to distinguish adenomyosis from leiomyoma and normal myometrium. A stepwise approach of transvaginal ultrasound with standardized MUSA reporting, supplemented by 3D imaging, Doppler and elastography in uncertain cases, with MRI reserved for complex situations, is an accurate and affordable strategy for routine gynecological practice.