Validation of the revised MUSA criteria for sonographic detection of adenomyosis

Abstract

Objective(s): This study aims to assess the diagnostic accuracy of the revised Morphologic Uterus Sonographic Assessment (MUSA) criteria for adenomyosis.

Methods: Retrospective review on 96 patients who underwent hysterectomy following ultrasound assessment between 1/3/2020-11/30/2023 for clinical reasons. Two blinded physician reviewers independently evaluated ultrasound images using the modified MUSA criteria. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and interrater reliability of the modified MUSA criteria were determined using hysterectomy specimens as the reference gold standard.

Results: Reviewer 1 found the modified MUSA criteria were found to have a sensitivity of 63.2%, specificity of 65.5%, PPV of 54.4%, and NPV of 73.1%. For reviewer 2, sensitivity was 42.1%, specificity 62.1%, PPV 42.1%, and NPV 62.1%. Interrater agreement using Cohen's kappa was 72.9%.

Conclusion(s): The modified MUSA criteria demonstrate moderate sensitivity and specificity in diagnosing adenomyosis. Inter-rater agreement was moderate with 72.9% concordance between ultrasound examiners. While useful in clinical assessment, this study suggests that the modified MUSA criteria lack high specificity and sensitivity, limiting their standalone diagnostic reliability.

Keywords: Adenomyosis; Endometrium; MUSA criteria; Myometrium; Pelvic pain.