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Congress: ECR25
Poster Number: C-17843
Type: Poster: EPOS Radiographer (educational)
DOI: 10.26044/ecr2025/C-17843
Authorblock: G. C. V. Lauar, M. C. V. Lauar, A. G. Afonso, S. B. Maksoud, P. C. Silva Júnior, A. L. S. Marques, C. C. Barbisan; Sao Paulo/BR
Disclosures:
Gabriela Caetano Vilela Lauar: Nothing to disclose
Marcela Caetano Vilela Lauar: Nothing to disclose
Ana Gaetan Afonso: Nothing to disclose
Sofia Bezerra Maksoud: Nothing to disclose
Paulo Claudino Silva Júnior: Nothing to disclose
Ana Luiza S. Marques: Nothing to disclose
Cinthia Callegari Barbisan: Nothing to disclose
Keywords: Genital / Reproductive system female, Ultrasound, Education, Education and training
Findings and procedure details

Advances in transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI) have aided in the non-invasive diagnosis of adenomyosis in younger women (4,5). TVUS is the initial examination in the investigation of patients with dysmenorrhoea and abnormal uterine bleeding, as it offers high sensitivity and specificity (similar to MRI) (2, 4), reported at 72% and 81%, respectively, according to Hiroshi Kobayashi (5). 

Three-dimensional (3D) transvaginal ultrasound (TVS) has been shown to enhance diagnostic accuracy for adenomyosis by providing a more detailed visualisation of changes in the junctional zone compared to two-dimensional (2D) ultrasound (1). The application of the MUSA criteria, combining 2D and 3D ultrasound, can increase specificity by 2%, also according to Kobayashi (5).

The sonographic features of adenomyosis commonly reported in the literature include myometrial changes, such as hypoechoic striations, myometrial cysts, heterogeneous regions, asymmetrical myometrial walls, diffuse vascularity, and a globular uterine shape (6).

Coronal reconstructions of the uterus are a useful adjunct to conventional imaging in the sagittal and transverse planes (7). Viewing the coronal plane through the endometrium on either 2D or 3D reconstructed images allows for complete visualization of the fundal endometrial-myometrial interface, which is the most common location for focal adenomyosis (7). Small regions of widening or disruption in the lateral and fundal junctional zone can be visualized in the coronal plane but are often impossible to appreciate on traditional 2D images (7). 

In a study conducted by Marque et al., adenomyosis findings were detected in 43 out of 78 patients: by 2D TVUS alone in 1 patient, by 3D TVUS alone in 2 patients, and by both 2D and 3D TVUS in 40 patients (55.1%) (7).

In our pictorial essay, we demonstrate a series of cases in which the use of 3D ultrasound complemented the diagnosis made with 2D ultrasound or even revealed adenomyosis findings that were not detected on 2D ultrasonography.
GALLERY