{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T04:05:14Z","timestamp":1784174714861,"version":"3.55.0"},"reference-count":31,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: The introduction of the Morphological Uterus Sonographic Assessment (MUSA) 2022 criteria for diagnosing adenomyosis has reduced diagnoses compared with previous criteria. However, the impact of each ultrasonographic sign on diagnosis and symptom management remains unexplored. Methods: We retrospectively re-evaluated data from our 2015 study, which used criteria available before the first MUSA consensus. Nulligravid women aged 18\u201330 years without endometriosis were included to determine whether MUSA 2022 criteria result in fewer diagnoses than previous criteria. Sonographic images were reviewed and MUSA 2022 criteria applied. The primary outcome was to estimate previous overdiagnosis; the secondary outcome was to identify correlations between ultrasound features and symptoms. Results: Among 156 patients, at least one direct MUSA 2022 sign was present in 36 women; 17 had only indirect signs; and 103 had no ultrasound signs. MUSA 2022 criteria reduced adenomyosis prevalence from 34% to 23.1%. Direct signs were associated with greater dyspareunia (44.4% vs. 11.8%) and higher VAS scores. Hypermenorrhoea was associated with asymmetrical thickness (Odds Ratio 2.84) and a globular uterus (Odds Ratio 4.03). Conclusions: Applying MUSA 2022 criteria reduces adenomyosis diagnoses, suggesting that previous criteria may have overestimated prevalence. Nevertheless, ultrasound remains an adjunct to clinical assessment, and symptoms should guide management when direct signs are absent.<\/jats:p>","DOI":"10.3390\/jcm15145554","type":"journal-article","created":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T03:34:23Z","timestamp":1784172863000},"page":"5554","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Transvaginal Sonographic Features of Diffuse Adenomyosis and Associated Symptoms in 18\u201330-Year-Old Nulligravid Women Without Endometriosis: Is Our Diagnosis Still Valid 10 Years Later? A Re-Evaluation of Previous Results"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-2773-1375","authenticated-orcid":false,"given":"Irene","family":"Colombi","sequence":"first","affiliation":[{"name":"Gynecology and Obstetric Department, Azienda USL Toscana Centro, Santo Stefano Hospital, 59100 Prato, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0756-535X","authenticated-orcid":false,"given":"Francesco Giuseppe","family":"Martire","sequence":"additional","affiliation":[{"name":"Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-0325-6744","authenticated-orcid":false,"given":"Eugenia","family":"Costantini","sequence":"additional","affiliation":[{"name":"Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0895-1567","authenticated-orcid":false,"given":"Ilaria","family":"Ianes","sequence":"additional","affiliation":[{"name":"Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3532-406X","authenticated-orcid":false,"given":"Luca","family":"Labanca","sequence":"additional","affiliation":[{"name":"Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3821-201X","authenticated-orcid":false,"given":"Caterina","family":"Exacoustos","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, Obstetrics and Gynecological Clinic, University of Rome Tor Vergata, Viale Oxford, 81, 00133 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Errico","family":"Zupi","sequence":"additional","affiliation":[{"name":"Gynecology and Obstetric Department, Azienda USL Toscana Centro, Santo Stefano Hospital, 59100 Prato, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9513-1980","authenticated-orcid":false,"given":"Lucia","family":"Lazzeri","sequence":"additional","affiliation":[{"name":"Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1883","DOI":"10.1007\/s00404-022-06852-2","article-title":"Sonographic features of adenomyosis correlated with clinical symptoms and intraoperative findings: A case\u2013control study","volume":"307","author":"Kasoha","year":"2023","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1016\/j.jmig.2021.08.023","article-title":"Ultrasound Findings of Adenomyosis in Adolescents: Type and Grade of the Disease","volume":"29","author":"Exacoustos","year":"2022","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1016\/j.jmig.2019.11.001","article-title":"Noninvasive Diagnosis of Adenomyosis: A Structured Review and Meta-analysis of Diagnostic Accuracy in Imaging","volume":"27","author":"Tellum","year":"2020","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"114639","DOI":"10.1016\/j.ejogrb.2025.114639","article-title":"Severe dysmenorrhea in adolescents need non-invasive ultrasound evaluation to early detect endometriosis\/adenomyosis","volume":"313","author":"Exacoustos","year":"2025","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"103003","DOI":"10.1016\/j.jogoh.2025.103003","article-title":"Ultrasound Follow-Up in young women with severe dysmenorrhea predicts early onset of endometriosis","volume":"54","author":"Nocita","year":"2025","journal-title":"J. Gynecol. Obstet. Hum. Reprod."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1002\/uog.24786","article-title":"Consensus on revised definitions of Morphological Uterus Sonographic Assessment (MUSA) features of adenomyosis: Results of modified Delphi procedure","volume":"60","author":"Harmsen","year":"2022","journal-title":"Ultrasound Obstet. Gyne"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"730","DOI":"10.1002\/uog.14834","article-title":"Transvaginal sonographic features of diffuse adenomyosis in 18\u201330-year-old nulligravid women without endometriosis: Association with symptoms","volume":"46","author":"Pinzauti","year":"2015","journal-title":"Ultrasound Obstet. Gyne"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1002\/uog.8900","article-title":"Adenomyosis: Three-dimensional sonographic findings of the junctional zone and correlation with histology","volume":"37","author":"Exacoustos","year":"2011","journal-title":"Ultrasound Obstet. Gyne"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1016\/j.bpobgyn.2014.04.010","article-title":"Imaging for the evaluation of endometriosis and adenomyosis","volume":"28","author":"Exacoustos","year":"2014","journal-title":"Best Pract. Res. Clin. Obstet. Gynaecol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1002\/uog.14806","article-title":"Terms, definitions and measurements to describe sonographic features of myometrium and uterine masses: A consensus opinion from the Morphological Uterus Sonographic Assessment (MUSA)","volume":"46","author":"Dueholm","year":"2015","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1002\/uog.26197","article-title":"Accuracy of ultrasound signs on two-dimensional transvaginal ultrasound in prediction of adenomyosis: Prospective multicenter study","volume":"62","author":"Krentel","year":"2023","journal-title":"Ultrasound Obstet. Gyne"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Yavuz, O., Akd\u00f6ner, A., \u00d6zgozen, M.E., Ertan, B., Kurt, S., Uluku\u015f, E.C., and G\u00fcney, M. (2024). Prediction of adenomyosis according to revised definitions of morphological uterus sonographic assessment features. Front. Med., 11.","DOI":"10.3389\/fmed.2024.1387515"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1093\/humrep\/det451","article-title":"Is adenomyosis associated with menorrhagia?","volume":"29","author":"Naftalin","year":"2014","journal-title":"Hum. Reprod."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2427","DOI":"10.1093\/humrep\/16.11.2427","article-title":"Ultrasonography compared with magnetic resonance imaging for the diagnosis of adenomyosis: Correlation with histopathology","volume":"16","author":"Bazot","year":"2001","journal-title":"Hum. Reprod."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2289","DOI":"10.1002\/jum.15635","article-title":"Diagnostic Accuracy of Transvaginal Ultrasound and Magnetic Resonance Imaging for Adenomyosis: Systematic Review and Meta-Analysis and Review of Sonographic Diagnostic Criteria","volume":"40","author":"Liu","year":"2021","journal-title":"J. Ultrasound Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1016\/j.jmig.2025.07.024","article-title":"Diagnostic Accuracy of Ultrasound for Adenomyosis-A Blinded, Retrospective, Single-Expert Validation Study of the 2022 MUSA Guidelines","volume":"32","author":"Maghsoudlou","year":"2025","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Vidal, A., Tepasse, P., Vinayahalingam, V., Cottagnoud, S., Gulz, M., Karrer, T., Yilmaz, G., Pape, J., and von Wolff, M. (2025). Uterine Contractility Changes in Adenomyosis: Evidence from a Systematic Review and Meta-Analysis. Biomedicines, 13.","DOI":"10.3390\/biomedicines13112728"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1016\/j.rbmo.2018.12.033","article-title":"Two- and three-dimensional transvaginal ultrasonography for diagnosis of adenomyosis of the inner myometrium","volume":"38","author":"Rasmussen","year":"2019","journal-title":"Reprod. Biomed. Online"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"3432","DOI":"10.1093\/humrep\/des332","article-title":"How common is adenomyosis? A prospective study of prevalence using transvaginal ultrasound in a gynaecology clinic","volume":"27","author":"Naftalin","year":"2012","journal-title":"Hum. Reprod."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e2981","DOI":"10.6061\/clinics\/2021\/e2981","article-title":"Association of 2D and 3D transvaginal ultrasound findings with adenomyosis in symptomatic women of reproductive age: A prospective study","volume":"76","author":"Marques","year":"2021","journal-title":"Clinics"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1002\/jcu.23712","article-title":"The association between sonographic features and clinical symptoms of adenomyosis","volume":"52","author":"Rudaitis","year":"2024","journal-title":"J. Clin. Ultrasound"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"185","DOI":"10.5114\/pm.2024.145950","article-title":"New MUSA classification of adenomyosis: Correlation of symptoms and clinical severity with direct and indirect features","volume":"23","author":"Jha","year":"2024","journal-title":"Menopause Rev.\/Przegl\u0105d Menopauzalny"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1002\/uog.19096","article-title":"Sonographic classification and reporting system for diagnosing adenomyosis","volume":"53","author":"Dueholm","year":"2019","journal-title":"Ultrasound Obstet. Gyne"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Biasioli, A., Degano, M., Restaino, S., Bagolin, M., Moro, F., Ciccarone, F., Testa, A.C., Greco, P., Scambia, G., and Vizzielli, G. (2024). Innovative Ultrasound Criteria for the Diagnosis of Adenomyosis and Correlation with Symptoms: A Retrospective Re-Evaluation. Biomedicines, 12.","DOI":"10.3390\/biomedicines12020463"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Selntigia, A., Molinaro, P., Tartaglia, S., Pellicer, A., Galliano, D., and Cozzolino, M. (2024). Adenomyosis: An Update Concerning Diagnosis, Treatment, and Fertility. J. Clin. Med., 13.","DOI":"10.3390\/jcm13175224"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"100099","DOI":"10.1016\/j.jeud.2024.100099","article-title":"Focal what focal?\u2014The diverse entities within focal adenomyosis","volume":"9","author":"Haesen","year":"2025","journal-title":"J. Endometr. Uterine Disord."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1154","DOI":"10.1016\/j.fertnstert.2018.06.031","article-title":"A sonographic classification of adenomyosis: Interobserver reproducibility in the evaluation of type and degree of the myometrial involvement","volume":"110","author":"Lazzeri","year":"2018","journal-title":"Fertil. Steril."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1080\/09513590.2018.1505846","article-title":"Ulipristal acetate therapy increases ultrasound features of adenomyosis: A good treatment given in an erroneous diagnosis of uterine fibroids","volume":"35","author":"Conway","year":"2019","journal-title":"Gynecol. Endocrinol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2447","DOI":"10.1007\/s43032-024-01541-8","article-title":"Type and Location of Adenomyosis in Women with Recurrent Pregnancy Loss: A Transvaginal Ultrasonographic Assessment","volume":"31","author":"Exacoustos","year":"2024","journal-title":"Reprod. Sci."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1093\/humrep\/deaa307","article-title":"Adenomyosis of the inner and outer myometrium are associated with different clinical profiles","volume":"36","author":"Bourdon","year":"2021","journal-title":"Hum. Reprod."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1002\/jum.16667","article-title":"Differences in the Sonographic Features of Adenomyosis and Concurrent Endometriosis Compared to Isolated Adenomyosis: A MUSA Criteria Analysis","volume":"44","author":"Matot","year":"2025","journal-title":"J. Ultrasound Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/14\/5554\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T03:58:00Z","timestamp":1784174280000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/14\/5554"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,15]]},"references-count":31,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["jcm15145554"],"URL":"https:\/\/doi.org\/10.3390\/jcm15145554","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,15]]}}}