Context: Preoperative diagnosis of uterine adenomyosis is a challenging problem. In a developing country like India, ultrasound is still the diagnostic modality of choice. This study was done to compare Trans vaginal ultrasound (TVS) and Magnetic resonance imaging (MRI) for diagnosis and evaluation of adenomyosis taking Histopathology as a gold standard so as to improvise on current clinical practices. Method : A prospective comparison study was done upon fifty patients who underwent TVS and MRI and then surgery. Data was subjected to various statistical tests. Result: The diagnostic sensitivity and specificity of TVS/ MRI were 50% /75% , 93.33%/ 86.67%, respectively , Kappa i.e. agreement between TVS and MRI v/s HPE was 0.464 and 0.622 respectively. The diagonal agreement between TVS and MRI was 46% . Conclusion: MRI is more sensitive, comparably specific modality having better diagonal agreement with HPE than TVS