**6. Diagnosis**

#### **6.1 Ultrasound sonography**

Imaging with transvaginal ultrasound (TVUS) can identify the subtle myometrial changes of adenomyosis, the findings may include: (1) the anterior or posterior myometrial wall appearing thicker, (2) small myometrial hypoechoic cysts, (3) endometrium JZ extending into the myometrium, (4) appearance of

#### *Endometriosis*

focal adenomyosis as discrete hypoechoic nodules that may be differentiated from leiomyoma by poorly defined margins, and (5) myometrial hyperplasia. Threedimensional transvaginal ultrasonography can improve the diagnostic accuracy with variable ranges of sensitivity between 70 and 93% and specificity between 86 and 93% for diagnosing adenomyosis by TVUS [16].
