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 [2]. Depending on the location of the disease (internal or external), the pattern (diffuse or focal), the depth of myometrial involvement, and the presence of other pathologies, adenomyosis can exhibit a wide range of imaging findings [3]. Radiologists should be aware of atypical variants of adenomyosis, including adenomyoma, adenomyotic cyst, and mimickers of adenomyosis, such as leiomyoma, transient uterine contraction, and some other malignant conditions [4]. Furthermore, one should consider the impact of the menstrual phase effect on the junctional zone, postmenopausal status, and the usage of hormonal contraception as potential pitfalls [5].

In this poster, we aim to discuss the typical and atypical radiological features of adenomyosis and potential pitfalls and highlight the adenomyosis classification based on MR imaging.