Objective: To explore the diagnostic value of the imaging features of hysterosalpingography (HSG) combined with clinical factors for intrauterine adhesions(IUA), and to evaluate its diagnostic performance in different types of IUA. Methods: A retrospective analysis was conducted on the clinical data of patients with suspected IUA who underwent diagnostic HSG at the Department of Intervention Radiology, Women's Hospital of Nanjing Medical University, between January 2019 and October 2024, and subsequently completed hysteroscopy. This cohort included 282 patients suspected of IUA (including 164 with preoperative three-dimensional ultrasound data). Univariate analysis was conducted to evaluate HSG imaging features, including the number and location of filling defects, tubal occlusion, and uterine cavity morphology, as well as clinical characteristics such as history of intrauterine procedures, abortion count, and menstrual flow reduction, etc. Variables demonstrating statistical significance (P < 0.05) were subsequently included in multivariate ordinal logistic regression analysis to identify independent predictors. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic and classification value of combined HSG imaging features and clinical factors for IUA. This value was further compared with that of three-dimensional ultrasound. Results: Hysteroscopy confirmed IUA in 251 cases (89.0%), who were further categorized according to the American Fertility Society (AFS) classification system into no IUA (n=31), mild IUA (n=64), moderate IUA (n=129), and severe IUA (n=58). The predictive factors of clinical features including induced abortion and imaging features including uterine filling defect were screened. For the diagnosis of IUA, the area under the receiver operating characteristic curve(AUC) was 0.920, with a sensitivity of 87.3% and a specificity of 80.7%. The AUC values for diagnosing mild IUA and severe IUA were 0.704 and 0.786, respectively, with sensitivities of 46.9% and 77.6%, and specificities of 87.6% and 65.2%. In comparison, three-dimensional ultrasound has shown a sensitivity of 81.4% and a specificity of 68.4% for diagnosing IUA. Conclusion: The combination of HSG imaging features and clinical features through multi-parameter indicators can effectively diagnose IUA and demonstrate good discriminatory efficacy for distinguishing between mild and severe IUA, and serves as a reliable tool for non-invasive screening while providing a basis for clinical stratified management.