Background: Uterine adenomyosis (UA) is common noncancerous condition characterized by the presence of endometrial tissue within the myometrium. UA is often associated with adverse pregnancy outcomes and complications. Modern imaging techniques provide non-invasive means of identifying UA, with Magnetic Resonance Imaging (MRI) being particularly effective due to its high precision. The aim of this study is to assess the diagnostic accuracy of MRI, specifically Diffusion-weighted image (DWI) and T2*WI, in detecting UA.

Methods: A total of 24 female participants underwent MRI using diagnostic protocol that included T1WI, T2WI, T1 FS WI, DWI and T2*WI. The results of (advanced MRI) sequences were compared to those of conventional MRI, with histopathological verification after surgery as the gold standard.

Results: Adenomyotic lesions showing restricted diffusion accounted for 75% of cases, while 83.3% of lesions exhibited signal voids on T2*WI. Additionally, 70.8% of lesions displayed typical signal intensities on conventional MRI. The inclusion of DWI improved the diagnostic performance of MRI which was further enhanced by addition of T2*WI compared to conventional MRI. Conventional MRI had sensitivity (SE) of 80% and specificity (SP) of 66.7%, but these values were not statistically significant (p < 0.05). On the other hand, DWI had SE of 85% and SP of 66.7%, which was statistically significant (p< 0.05). T2*WI had SE of 94.7% and SP of 75%, which was even more statistically significant and could be reliably correlated with laparoscopy.

Conclusion: T2*WI and DWI can serve as reliable supplementary diagnostic sequences to conventional MRI in detection of UA.