THE NONSURGICAL DIAGNOSIS OF ADENOMYOSIS

Objective: To survey the nonsurgical diagnostic techniques for disting uishing adenomyosis, and to determine whether one technique offers dia gnostic advantages. Data Sources: We conducted a thorough search of th e MEDLINE data base and identified English-language papers on adenomyo sis published during the last 28 years. Reference lists of retrieved a rticles were also examined for additional source documents. Methods of Study Selection: We reviewed 238 articles. Papers on nonsurgical diag nostic techniques published in peer-reviewed journals were selected fo r inclusion. Data Extraction and Synthesis: We determined nonsurgical diagnostic techniques for distinguishing adenomyosis to be hysterosalp ingography, abdominal ultrasound, transvaginal sonography, and magneti c resonance imaging (MRI). Studies were divided into these four catego ries, reviewed, and summarized accordingly. Recent reports suggest tha t noninvasive modalities, eg, transvaginal sonography and MRI, have ma de possible the nonsurgical diagnosis of adenomyosis. Conclusion: Beca use of its widespread availability and patient tolerance, transvaginal sonography remains the primary screening modality for imaging the fem ale pelvis. However, for cases in which sonography cannot detect adeno myosis, MRI provides a viable alternative and should be the definitive diagnostic modality of choice.