Comparative diagnostic performance of transvaginal ultrasonography and magnetic resonance imaging in adenomyosis: An evidence-integrated review of accuracy, real-world evidence, and clinical implementation

Adenomyosis is a heterogeneous uterine disorder characterized by endometrial-like tissue within the myometrium. Diagnostic uncertainty has consequences for pain management, heavy menstrual bleeding, infertility counselling, and selection of uterus-sparing therapy.

Objective

To critically compare transvaginal ultrasonography (TVUS) and magnetic resonance imaging (MRI), and to establish a rigorous framework for evaluating diagnostic performance in routine care.

Methods

This integrative evidence review prioritizes comparative diagnostic meta-analyses, the revised Morphological Uterus Sonographic Assessment (MUSA) consensus, clinical guidance, and relevant methodological and regulatory publications. We distinguish published empirical findings from proposed analytical protocols; no original patient cohort, new meta -analysis, or causal treatment-effect analysis was performed. Results: