1 3 Radiol med DOI 10.1007/s11547-017-0729-7 MAGNETIC RESONANCE IMAGING MRI, US or real-time virtual sonography in the evaluation of adenomyosis? Valeria Vinci 1 · Matteo Saldari 1 · Maria Eleonora Sergi 1 · Silvia Bernardo 1 · Giuseppe Rizzo 2 · Maria Grazia Porpora 3 · Carlo Catalano 1 · Lucia Manganaro 1 Received: 23 November 2016 / Accepted: 22 January 2017 © Italian Society of Medical Radiology 2017 of these appeared as diffuse form and 8 as focal form, such as adenomyoma and adenomyotic cyst, thus resulting in 3 misdiagnosed cases on US. RVS confirmed all 22 cases of diffuse adenomyosis and all 8 cases of focal adenomyosis. Conclusions Thanks to information from both US and MRI, fusion imaging allows better identification of adeno- myosis and could improve the performance of ultrasound operator thus to implement the contribution of TVUS in daily practice. Keywords RVS · Adenomyosis · MRI Introduction Adenomyosis is a common benign condition, frequently occurring in the 4th decade, characterized by the presence of endometrial glands within the myometrium [1]. It is an estrogen-related pathology and, therefore, associated with uterine fibroids in a percentage between 35 and 80 [2]. Two-thirds of the patients affected by this condition are symptomatic, complaining about dysmenorrhea, abnormal bleeding and pelvic pressure. Until the past decade adenomyosis was only diagnosed by histology examination; however, since there were no standardized diagnostic features, its prevalence has a wide range on histology specimen counting between 5 and 70%. The improvement of new diagnostic imaging tools allowed an accurate preoperative diagnosis, demonstrating that the development of the disease begins earlier in life around the third decade, especially in women with coex- isting endometriosis [3]; in these patients, it is even more important to reach the correct diagnosis for the evaluation of fertility potentiality. Abstract Purpose Real-time virtual sonography (RVS) allows dis- playing and synchronizing real-time US and multiplanar reconstruction of MRI images. The purpose of this study was to evaluate the feasibility and ability of RVS to assess adenomyosis since literature shows US itself has a reduced diagnostic accuracy compared to MRI. Materials and methods This study was conducted over a 4-month period (March–June 2015). We enrolled in the study 52 women with clinical symptoms of dysmenor- rhea, methrorragia and infertility. Every patient underwent an endovaginal US examination, followed by a 3T MRI exam and a RVS exam (Hitachi HI Vision Ascendus). The MRI image dataset acquired at the time of the examination was loaded into the fusion system and displayed together with the US images. Both sets of images were then manu- ally synchronized and images were registered using multi- ple plane MR imaging. Radiologist was asked to report all three examinations separately. Results On a total of 52 patients, on standard endovaginal US, adenomyosis was detected in 27 cases: of these, 21 presented diffuse adenomyosis, and 6 cases focal form of adenomyosis. MRI detected adenomyosis in 30 cases: 22 * Lucia Manganaro lucia.manganaro@uniroma1.it 1 Department of Radiological Oncological and Anatomopathological Sciences, Umberto I Hospital, “Sapienza” University of Rome, Viale Regina Elena 324, 00161 Rome, Italy 2 Department of Obstetrics and Gynecology, University Roma Tor Vergata, Rome, Italy 3 Department of Obstetrics and Gynecology, Umberto I Hospital, “Sapienza” University of Rome, Viale Regina Elena 324, 00168 Rome, Italy