"How Is Adenomyosis Diagnosed?
The diagnosis can only be proven by the pathologists. This requires the microscopic evaluation of the uterus or tissue taken from the uterine wall.
Although it is possible for a surgeon to make the diagnosis by core-type needle biopsy, the sensitivity is very low. Unless an adenomyoma changes the natural contour of the uterus, the surgeon has no visual clues as to where the adenomyosis is. Therefore, accurate diagnosis would require multiple biopsy sites going deep into the uterus, plus a generous helping of luck.
Lately, we have heard the claim that MRI can diagnose adenomyosis.
MRI should be expected to be excellent in recognizing uterine masses like fibroids, cysts, and adenomyomas if they reach 5 mm. or greater in size. We expect that it will also add to the ability to differentiate among any of the above. MRI may be able to lead us to expect adenomyosis if the myometrial thickness is increased or the consistency of the myometrium is changed.
Unfortunately, this type of information will probably remain quite nonspecific. We are not hopeful that we will soon be able to rely on it to diagnose the isolated, scattered areas of glands lost among the muscle cells because of their small size. Much work is ongoing to get more information as to the diagnostic accuracy of this technique.
Ultrasonography or MRI may identify glandular islands in the myometrium. But as with pelvic endometriosis, the ultrasound can't usually be specific enough to diagnose endometriosis to the exclusion of other possibilities. A good gynecologist may suspect adenomyosis based on the clinical factors described below, but the final diagnosis usually has to wait until hysterectomy is performed." -- http://www.advancedobgynassociates.com/adenomyosis.htm