Comparison of TVS and MRI for Evaluating Adenomyosis in the Dhaka Metropolitan Area, Bangladesh

Abstract

Adenomyosis is a significant gynecologic cause of infertility, particularly in developing countries, where early diagnosis and accurate assessment of myometrial involvement are critical for appropriate risk categorization and surgical planning. While transvaginal ultrasound (TVS) is commonly used for pre-operative diagnosis, magnetic resonance imaging (MRI) is often considered superior for early and precise detection of adenomyosis. This cross-sectional study, conducted in the Department of Radiology and Imaging at BSMMU, Dhaka, aimed to evaluate the effectiveness of TVS and MRI in assessing myometrial invasion in adenomyosis. Both imaging techniques were performed on patients diagnosed with adenomyosis, and the results were compared with histopathology reports, which served as the gold standard. Statistical analysis was conducted using SPSS version 25.0. The study revealed that the majority of patients (56.7%) were aged 36-45 years, with a mean age of 41.15 years, and pelvic pain was the most common symptom, reported by 63.3% of patients. Adenomyosis was detected in 61.7% of patients using TVS and in 68.3% using MRI, with histopathology confirming the condition in 65% of cases. Among these, 53.8% had diffuse adenomyosis, while 46.2% had focal adenomyosis. MRI demonstrated a higher diagnostic accuracy with a sensitivity of 87.2%, specificity of 66.7%, positive predictive value (PPV) of 82.9%, and negative predictive value (NPV) of 73.7%, compared to TVS, which had a sensitivity of 71.8%, specificity of 57.1%, PPV of 75.7%, and NPV of 52.2%. These findings suggest that MRI is more reliable than TVS for detecting adenomyosis, though further studies are needed to confirm these results.