Occurrence of endometrial tissue in the myometrium is adenomyosis. These patients usually presents with excessive per vaginal bleeding and dysmenorrhea. Diagnosis of adenomyosis is considered difficult with MRI and ultra sound scan. In a case control study Acoustic radiation force impulse (ARFI) and color elastography were used to determine the elasticity of hysterectomy specimens of patients undergoing indicated surgeries. Elasticity measurements of tissue with adenomyosis were significantly higher than measurements of normal myometrial tissue. Accordingly, adenomyosis tissue is significantly softer than the normal myometrium. So that ARFI was found to be beneficial in differentiating myometrial tissue with adenomyosis from normal myometrial tissue and it was found to be useful to implement ARFI in diagnosis of adenomyosis.(1)
In a case control study, first the relationship between lesional stiffness and lesional histology in cases with histologically confirmed adenomyosis in comparison with tissue stiffness in control myometrial and uterine fibroids tissue samples were evaluated. Then validated the relationship between lesional stiffness and the severity of dysmenorrhea .Transvaginal ultrasound and transvaginal electrosonography were both performed. It was found that the stiffness of adenomyosis lesions was significantly higher than that of uterine fibroids. Lesional stiffness had a correlation with the dysmenorrhea severity as well as the amount of menstruation. Accordingly, transvaginal electrosonography can improve the diagnostic accuracy for adenomyosis, especially in differential diagnosis.(2)
In a study done to evaluate the contribution of transvaginal sonography (TVS) and magnetic resonance imaging (MRI) to diagnose adenomyosis MRI had a sensitivity of 0.77, specificity of 0.89 for all sub types internal , external and adenomyoma.(3)

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