Diagnosis of adenomyosis
The diagnosis of adenomyosis was based on transvaginal ultrasound and/or
magnetic resonance imaging (MRI) performed before conception and/or
during the first or second trimester of pregnancy. On transvaginal
ultrasound, adenomyosis was diagnosed based on the Morphological Uterus
Sonographic Assessment (MUSA) criteria established in 2019: asymmetrical
thickening, cysts, hyperechoic islands, fan-shaped shadowing, echogenic
subendometrial lines and buds, translesional vascularity, irregular
junctional zone, and interrupted junctional zone.(16) On MRI,
adenomyosis was diagnosed when one of the following two diagnostic
criteria were met: 1) presence of a myometrial mass with indistinct
margins with primarily low signal intensity, or 2) diffuse or focal
thickening of the junctional zone forming an ill-defined area of low
signal intensity on T2-weighted images.(17)