Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jun 14.
doi: 10.1007/s00261-025-05039-y. Online ahead of print.

Validation of the revised MUSA criteria for sonographic detection of adenomyosis

Shekinah D Dosunmu  1 , Albert Sarno  2 , Eunice Lee  2 , Cassandra Mitchell  2 , Julia Wang  2 , Kyle Shaak  3
Affiliations

Validation of the revised MUSA criteria for sonographic detection of adenomyosis

Shekinah D Dosunmu et al. Abdom Radiol (NY). .

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.

PubMed Disclaimer

Conflict of interest statement

Declarations. Conflict of interest: The authors declare no competing interests. Collaborators: Not applicable.

References

    1. Habiba M, Guo S-W, Benagiano G. Adenomyosis and abnormal uterine bleeding: review of the evidence. Biomolecules. 2024;14(6):616. https://doi.org/10.3390/biom14060616 - DOI - PubMed - PMC
    1. Vannuccini S, Tosti C, Carmona F, Huang SJ, Chapron C, Guo SW, Petraglia F. Pathogenesis of adenomyosis: an update on molecular mechanisms. Reprod Biomed Online. 2017;35(5):592–601. https://doi.org/10.1016/j.rbmo.2017.06.016 - DOI - PubMed
    1. Nirgianakis K, Kalaitzopoulos DR, Schwartz ASK, et al. Fertility, pregnancy and neonatal outcomes of patients with adenomyosis: a systematic review and meta-analysis. Reprod Biomed Online. 2021;42(1):185–206. https://doi.org/10.1016/j.rbmo.2020.09.023 . - DOI - PubMed
    1. Struble J, Reid S, Bedaiwy MA. Adenomyosis: a clinical review of a challenging gynecologic condition. J Minim Invasive Gynecol. 2016;23(2):164–185. https://doi.org/10.1016/j.jmig.2015.09.018 - DOI - PubMed
    1. Schrager S, Yogendran L, Marquez CM, Sadowski EA. Adenomyosis: diagnosis and management. Am Fam Physician. 2022;105(1):33–38 - PubMed

LinkOut - more resources