Assessment of rectovaginal endometriosis using three‐dimensional gel‐infusion sonovaginography

Abstract

Deep infiltrating endometriosis (DIE) is characterized by the presence of foci of ectopic endometrial tissue, fibrosis and muscular hyperplasia that have penetrated more than 5 mm into the affected pelvic organs. Rectovaginal endometriosis is considered the most severe form of DIE, defined as infiltration by endometriotic lesions of both the rectum and the posterior vaginal fornix with possible extension to the rectovaginal septum 1 .The gold standard method for diagnosis of DIE is laparoscopy with biopsy 2 . However, this approach is inadequate for lesions located in the rectovaginal septum and posterior vaginal fornix because these structures are in the posterior cul-de-sac, below the peritoneal reflection, and sometimes this area is obliterated by the disease and is not visible by laparoscopy. Similarly, conventional transvaginal sonography (TVS) has lower sensitivity for detection of DIE in this area than in other sites 3,4 . BLADDER VAGINA Figure 1 3D transvaginal ultrasound images using multiplanar mode (a) and rendering mode (b), showing sagittal view of rectovaginal septum (arrows), cervix (C), rectum ( ) and posterior fornix (arrowhead).

A prospective study comparing rectal water contrast‐transvaginal ultrasonography with sonovaginography for the diagnosis of deep posterior endometriosis

“… 22 It has recently been reported that 3D reconstruction of the coronal plane may allow for better visualization of pelvic structures, such as the posterior vaginal fornix and rectovaginal septum. 36 According to our experience, 37 3D modality should be complementary to 2D scan and be done dynamically during ultrasonographic examination. However, we deem that the main advantages of using 3D reconstructions are the estimation of the volume of DE nodules by VOCAL technique and the contribution in evaluating the degree of the stenosis of the bowel lumen in patients with rectosigmoid nodules at RWC‐TVS (Figure 1 and Figure S2 ); obviously, this was not possible by SVG, which is not based on the distention of the bowel lumen.…”

“…Moreover, 3D acquisitions, being assessed off‐line by a dedicated post‐processing software, can be manipulated, rotated or scrolled through, in fascinating virtual navigation 22 . It has recently been reported that 3D reconstruction of the coronal plane may allow for better visualization of pelvic structures, such as the posterior vaginal fornix and rectovaginal septum 36 . According to our experience, 37 3D modality should be complementary to 2D scan and be done dynamically during ultrasonographic examination.…”

A Novel Ultrasound Technique Called Saline Infusion SonoPODography to Visualize and Understand the Pouch of Douglas and Posterior Compartment Contents: A Feasibility Study

“…Without necessarily saying so, this obviously demonstrates there is an understanding that fluid in the POD is valuable for evaluating the posterior compartment and mapping disease with US. Moreover, sonovaginography, a technique that uses gel in the vagina to create a standoff view of the posterior compartment, including the RVS, has been studied and adapted with 3D technology . However, the sensitivity and positive predictive value of US for RVS disease could be improved .…”

“…Moreover, sonovaginography, a technique that uses gel in the vagina to create a standoff view of the posterior compartment, including the RVS, has been studied 16 and adapted with 3D technology. 17 However, the sensitivity and positive predictive value of US for RVS disease could be improved. 3 In this era of a standardized approach to US performance and interpretation for endometriosis, SPG may be useful to advance our ability to map and measure disease in difficult-to-visualize anatomic areas.…”

Endometriosis in Menopause—Renewed Attention on a Controversial Disease

“…The data available in literature is limited, with only a few reports from Brazil, Italy, Romania, and Australia, but the methods seems beneficial in the diagnosis of posterior deep infiltrating endometriosis. Up to date, no studies have reported its use in postmenopausal patients [22,[31][32][33].…”