To review the basics of uterine adenomyosis To discuss the proposed classification and reporting of adenomyosis based on MR imaging findings. To provide atypical variants and mimickers of adenomyosis

Adenomyosis is a prevalent benign gynecological condition characterized by ectopic endometrial glands and stroma within the myometrium, leading to hypertrophy and hyperplasia of smooth muscle cells [1]. Dysmenorrhea, menorrhagia, abnormal uterine bleeding, and chronic pelvic pain are frequently encountered symptoms; however, they do not provide a conclusive diagnosis. Thus, imaging is crucial for accurate preoperative diagnosis to prevent unnecessary intervention. Magnetic resonance imaging (MRI) is a highly precise, noninvasive technique used to diagnose adenomyosis, distinguish it from other gynecologic disorders, and determine suitable treatment strategies...

1.Pathogenesis of adenomyosis [6] (Figure 1)[Fig 1]Invasion of endometrial basalis into the myometrium-Invasion of altered endometrial basalis cells into myometrium through an injured or abnormal junctional zone.-Associated with junctional zone thickening and internal adenomyosisDe novo metaplasia from stem cells-Forming of ectopic endometrium by de novo metaplasia of embryonic epithelial progenitors (remnants) or by differentiation of adult endometrial stem cells that migrate to the myometrium.Outside-to-inside invasion induced by retrograde menstruation-Implantation of stem cells through retrograde menstruation and invasion of the outer myometrium-Associated with external adenomyosis2.Junctional Zone...

Adenomyosis can be accurately diagnosed by using MRI, which also has the capability to identify any accompanying pathologies. It is crucial to have knowledge of both the typical and atypical features of adenomyosis and to remain vigilant about potential diagnostic challenges to ensure an accurate diagnosis.

B. Ergin: Nothing to disclose D. Sungur: Nothing to disclose O. Şahin: Nothing to disclose E. Aydin: Nothing to disclose H. Şahin: Nothing to disclose

1-Agostinho, L., Cruz, R., Osório, F., Alves, J., Setúbal, A., & Guerra, A. (2017). MRI for adenomyosis: a pictorial review. Insights into imaging, 8(6), 549–556. https://doi.org/10.1007/s13244-017-0576-z2-Celli, V., Dolciami, M., Ninkova, R., Ercolani, G., Rizzo, S., Porpora, M. G., Catalano, C., & Manganaro, L. (2022). MRI and Adenomyosis: What Can Radiologists Evaluate?. International journal of environmental research and public health, 19(10), 5840. https://doi.org/10.3390/ijerph191058403-Kobayashi, H., & Matsubara, S. (2020). A Classification Proposal for Adenomyosis Based on Magnetic Resonance Imaging. Gynecologic and obstetric investigation, 85(2), 118–126. https://doi.org/10.1159/0005056904-Tamai, K.,...