Ultrasound in Adenomyosis: Unmasking the Bulky Uterus

Adenomyosis is often called the “sister” of endometriosis, where the endometrial glands grow into the muscular wall (myometrium) of the uterus. While it often results in a “globular” or enlarged uterus, accurate diagnosis requires advanced imaging like 3D Ultrasound and sometimes MRI.

3D Ultrasonography & Junctional Zone

3D sonography is a game-changer for identifying the Junctional Zone (JZ)—the inner layer of the myometrium. On a coronal view, we look for:

• An ill-defined or distorted junctional zone.
• Infiltration of the hypoechoic inner myometrium.
• Localised or diffuse thickening of the transition zone (the hypoechoic halo).

Specific Sonographic Signs

At Talwar Fertility & Child Health Centre, we look for these specific “fingerprints” of adenomyosis during your scan:

The Role of Colour Doppler

Unlike fibroids which often have a clear circular blood supply, Adenomyosis shows diffuse hypervascularity throughout the stroma. Colour Doppler helps us identify these intramural cysts and distinguish them from other uterine masses.

MRI: When Do We Need It?

MRI is an excellent confirmatory tool. The key MRI criteria for adenomyosis include:

• Increased JZ Thickness: A junctional zone thickness of ≥12 mm (or 0.15 mm in specific T2 weighted sequences).
• Globular Enlargement: Uterine length often reaching up to 12 cm.
• High Intensity Spots: Diffuse widening of the JZ on T2 weighted images.

Impact on IVF

Adenomyosis can affect embryo implantation. Once we manage the condition and the follicles reach the optimal size (≥2 follicles over 18 mm), we proceed with a carefully timed HCG/GnRH trigger to ensure the best chances for IVF success in a receptive environment.