25 Non-invasive diagnosis - Ultrasound In daily gynaecological practice, adenomyosis is often first suspected (alongside presence of corresponding symptoms) on the basis of the aspect of the uterus on trans-vaginal ultrasound (TVUS). Characteristics indicative of adenomyosis are generally described according to the MUSA (Morphological Uterus Sonographic Assessment (28)) criteria (see Figure 1.4). The reported sensitivity, specificity, and Area Under the Curve (AUC) of TVUS are (with 95% CI) 74% (SD 68%–79%), 76% (SD 71%–79%), and 0.7 respectively (29). See Figure 1.5 for illustrative examples on TVUS. Figure 1.4. Sonographic characteristics of Adenomyosis according to the Morphological Uterine Sonographic Assessment (MUSA) Criteria of Van den Bosch et al. 2015 (30) Despite the possibility to fairly accurately diagnose adenomyosis on standard TVUS, there are several limitations that should be considered. One problem posed by diagnosing adenomyosis by TVUS is in that it is susceptible to interobserver variability (29,31–34), which often depends on the experience and expertise of the ultrasound technician or physician (35). As such, specifically in cases of mild or atypical adenomyosis, adenomyosis is easily overlooked. It
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