Diagnosis of pelvic adhesions in patients with endometrioma: the role of transvaginal ultrasonography

Guerriero, S.; Ajossa, Silvia; Garau, Nicoletta; Alcázar, Juan Luis; Mais, Valerio; Melis, Gian Benedetto

doi:10.1016/j.fertnstert.2009.03.035

Cited by 48 publications

(34 citation statements)

References 24 publications

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“…Fusion imaging has great potential in the assessment of endometriosis because it combines the advantages of TVS and MR imaging modalities, and correspondingly overcomes their weaknesses, providing superior spatial, contrast and temporal resolution to that possible with each technique alone. As well as the tissue contrast capabilities of MRI, it benefits from the dynamic, real‐time qualities of TVS which allow diagnosis of adhesions, a major component in DIE: TVS assessment of endometriotic lesions includes applying gentle pressure with the transvaginal probe in the area of interest to determine the fixation of the endometriotic nodule to adjacent structures.…”

Section: Discussionmentioning

confidence: 99%

Fusion imaging for evaluation of deep infiltrating endometriosis: feasibility and preliminary results

Millischer¹,

Salomon

Santulli

et al. 2015

Ultrasound in Obstet & Gyne

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Objective Magnetic resonance imaging (MRI) and ultrasound scanning complement each other in screening for and diagnosis of endometriosis. Fusion imaging, also known as real-time virtual sonography, is a new technique that uses magnetic navigation and computer : uterosacral ligaments: ultrasound, 88% (30/34); MRI, 100% (34/34); fusion imaging, 100% (34/34); posterior vaginal fornix: ultrasound, 88% (30/34); MRI, 100% (34/34); fusion imaging, 100% (34/34); rectum: ultrasound, 100% (17/17); MRI, 82.3% (14/17); fusion imaging, 100% (17/17); ureters: ultrasound, 0%; MRI, 100% (34/34)

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Section: Discussionmentioning

confidence: 99%

Fusion imaging for evaluation of deep infiltrating endometriosis: feasibility and preliminary results

Millischer¹,

Salomon

Santulli

et al. 2015

Ultrasound in Obstet & Gyne

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“…The technique for examination of adhesions was similar to that used in this paper but they do not state ovarian adhesions separately. Guerriero et al, [3] used a technique of applying pressure between the uterus and ovary. If they remained linked then this was suggestive of adhesions.…”

Section: Discussionmentioning

confidence: 99%

“…The prevalence of disease is also variable in different studies, which may bias the findings. Only a few studies have attempted to assess the ability of ultrasound examination to detect presence of pelvic adhesions in women with pelvic endometriosis and to assess their severity [2,3]. …”

Section: Introductionmentioning

confidence: 99%

Ultrasound mapping of pelvic endometriosis: does the location and number of lesions affect the diagnostic accuracy? a multicentre diagnostic accuracy study

et al. 2013

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BackgroundEndometriosis is a common condition which causes pain and reduced fertility. Treatment can be difficult, especially for severe disease, and an accurate preoperative assessment would greatly help in the managment of these patients. The objective of this study is to assess the accuracy of pre-operative transvaginal ultrasound scanning (TVS) in identifying the specific features of pelvic endometriosis and pelvic adhesions in comparison with laparoscopy.MethodsConsecutive women with clinically suspected or proven pelvic endometriosis, who were booked for laparoscopy, were invited to join the study. They all underwent a systematic transvaginal ultrasound examination in order to identify discrete endometriotic lesions and pelvic adhesions. The accuracy of ultrasound diagnosis was determined by comparing pre-operative ultrasound to laparoscopy findings.Results198 women who underwent preoperative TVS and laparoscopy were included in the final analysis. At laparoscopy 126/198 (63.6%) women had evidence of pelvic endometriosis. 28/126 (22.8%) of them had endometriosis in a single location whilst the remaining 98/126 (77.2%) had endometriosis in two or more locations. Positive likelihood ratios (LR+) for the ultrasound diagnosis of ovarian endometriomas, moderate or severe ovarian adhesions, pouch of Douglas adhesions, and bladder deeply infiltrating endometriosis (DIE), recto-sigmoid colon DIE, rectovaginal DIE, uterovesical fold DIE and uterosacral ligament DIE were >10, whilst for pelvic side wall DIE and any ovarian adhesions the + LH was 8.421 and 9.81 respectively.The negative likelihood ratio (LR-) was: <0.1 for bladder DIE; 0.1-0.2 for ovarian endometriomas, moderate or severe ovarian adhesions, and pouch of Douglas adhesions; 0.5-1 for rectovaginal, uterovesical fold, pelvic side wall and uterosacral ligament DIE. The accuracy of TVS for the diagnosis of both total number of endometriotic lesions and DIE lesions significantly improved with increasing total number of lesions.ConclusionsOur study has shown that the TVS diagnosis of endometriotic lesion is very specific and false positive results are rare. Negative findings are less reliable and women with significant symptoms may still benefit from further investigation even if TVS findings are normal. The accuracy of ultrasound diagnosis is significantly affected by the location and number of endometriotic lesions.

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“…Therefore, in women who are infertile or have chronic pelvic pain, and in the absence of ovarian endometriomas, it is important to look for sonographic signs of adhesions. Only a few studies have attempted to assess the ability of transvaginal sonographic examination to detect the presence of pelvic adhesions in women with pelvic endometriosis, and to assess their severity [32][33][34][35].…”

Section: Ultrasound Evaluationmentioning

confidence: 99%

“…Preoperative transvaginal and transrectal ultrasound have also been used to predict Stage 3 and 4 endometriosis (including pelvic adhesions) at laparoscopy, with a sensitivity and specificity of 86% and 82%, respectively, for Stage 3 and 76% and 91%, respectively, for Stage 4 disease [35]. Guerriero et al [32] used a technique of applying pressure between the uterus and ovary, and found that a combination of three features are suggestive of ovarian adhesions: blurring of the ovarian margin; the inability to mobilise the ovary on palpation (fixation); and an increased distance from the probe. Sensitivity and specificity of 89% and 90%, respectively, were reported for fixation of the ovaries to the uterus.…”

Section: Ultrasound Evaluationmentioning

confidence: 99%

Imaging for the evaluation of endometriosis and adenomyosis

Exacoustòs

Manganaro

Zupi

2014

Best Practice & Research Clinical Obstetrics & Gynaecol

212

143

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Endometriosis affects between 5 and 45% of women in reproductive age, is associated with significant morbidity, and constitutes a major public health concern. The correct diagnosis is fundamental in defining the best treatment strategy for endometriosis. Therefore, non-invasive methods are required to obtain accurate diagnoses of the location and extent of endometriotic lesions. Transvaginal sonography and magnetic resonance imaging are used most frequently to identify and characterise lesions in endometriosis. Subjective impression by an experienced sonologist for identifying endometriomas by ultrasound showed a high accuracy. Adhesions can be evaluated by real-time dynamic transvaginal sonography, using the sliding sign technique, to determine whether the uterus and ovaries glide freely over the posterior and anterior organs and tissues. Diagnosis is difficult when ovarian endometriomas are absent and endometriosis causes adhesions and deep infiltrating nodules in the pelvic organs. Magnetic resonance imaging seems to be useful in diagnosing all locations of endometriosis, and its diagnostic accuracy is similar to those obtained using ultrasound. Transvaginal ultrasound has been proposed as first line-line imaging technique because it is well accepted and widely available. The main limitation of ultrasound concerns lesions located above the rectosigmoid junction owing to the limited field-of-view of the transvaginal approach and low accuracy in detecting upper bowel lesions by transabdominal ultrasound. A detailed non-invasive diagnosis of the extension in the pelvis of endometriosis can facilitate the choice of a safe and adequate surgical or medical treatment

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Diagnosis of pelvic adhesions in patients with endometrioma: the role of transvaginal ultrasonography

Cited by 48 publications

References 24 publications

Fusion imaging for evaluation of deep infiltrating endometriosis: feasibility and preliminary results

Fusion imaging for evaluation of deep infiltrating endometriosis: feasibility and preliminary results

Ultrasound mapping of pelvic endometriosis: does the location and number of lesions affect the diagnostic accuracy? a multicentre diagnostic accuracy study

Imaging for the evaluation of endometriosis and adenomyosis

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