PURPOSE MRI is the current imaging gold standard to diagnose adenomyosis, but access is often limited by high costs and availability. Transvaginal ultrasound provides a cost-effective, accurate and readily available alternative. The objective of our study was to determine the diagnostic accuracy of commonly described sonographic findings in predicting uterine adenomyosis. METHODS This retrospective study evaluated 649 MRI studies performed to investigate adenomyosis with a preceding transvaginal ultrasound within 12 months between 2013 and 2018. Two blinded reviewers assessed the presence or absence of six sonographic features: bulky uterus, heterogeneous myometrium, streaky myometrium, myometrial cysts, endometrial-myometrial interface ill-definition, and echogenic linear striations. The sensitivity, specificity, positive and negative predictive values of these features were calculated individually and in combination when compared to MRI as the standard of reference. RESULTS Adenomyosis was found in 315 (48.5%) cases on MRI. Ultrasound had a high specificity of 91.8% (95% CI 88.4 to 94.6%) but was less sensitive (36.8% (95% CI 31.5 to 42.4%)) for detecting adenomyosis. Comorbid fibroids or focal adenomyosis did not affect diagnostic accuracy. All six variables were significantly more common in patients with adenomyosis compared to those without. Individually, 'bulky uterus' and 'heterogenous myometrium' each demonstrated a mean sensitivity and specificity > 50%. The best dual combined variables were 'bulky uterus' + 'ill definition of the endometrial-myometrial interface' (sensitivity 39%, specificity 91%). The best triple combined variables were 'bulky uterus', 'heterogeneous myometrium' + 'ill definition of the endometrial-myometrial interface' (sensitivity 38%, specificity 93%). CONCLUSION Transvaginal ultrasound is highly specific for diagnosing uterine adenomyosis, providing a cost-effective and readily available alternative to MRI.

中文翻译：

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超声诊断子宫腺肌病的结果准确性。

目的MRI是目前诊断子宫腺肌病的影像黄金标准，但是其访问通常受到高成本和高可用性的限制。经阴道超声提供了一种经济有效，准确且易于获得的替代方法。我们研究的目的是确定通常描述的超声检查结果在预测子宫腺肌病中的诊断准确性。方法这项回顾性研究评估了649项MRI研究，这些研究是在2013年至2018年的12个月内用先前的经阴道超声检查子宫腺肌症。两名盲人评价者评估了六个超声检查特征的存在与否：大子宫，异型子宫肌层，条纹状子宫肌层，子宫肌层囊肿，子宫内膜-子宫肌层界面不清晰，以及回声线性条纹。敏感性，特异性，与MRI作为参考标准相比，这些特征的阳性和阴性预测值是单独计算或组合计算的。结果MRI检出315例（48.5％）子宫腺肌病。超声具有91.8％（95％CI 88.4至94.6％）的高特异性，但对检测子宫腺肌病的敏感性较低（36.8％（95％CI 31.5至42.4％））。合并性肌瘤或局灶性子宫腺肌病不影响诊断准确性。与没有腺癌的患者相比，所有六个变量在患有子宫腺肌病的患者中明显更为常见。分别地，“大子宫”和“异源性子宫肌层”均显示出平均敏感性和特异性> 50％。最佳的双重组合变量是“子宫大” +“子宫内膜-子宫肌层界面的不良定义”（敏感性为39％，特异性为91％）。最好的三重组合变量是“大子宫”，“异质性子宫肌层” +“子宫内膜-子宫肌层界面的不良定义”（敏感性38％，特异性93％）。结论经阴道超声对子宫腺肌病的诊断具有很高的特异性，可提供一种经济有效的MRI替代方法。