Imaging diagnosis of endometriosis

Abstract

Endometrosis is a common gynecologic disease that affects women of reproductive age and commonly causes pelvic pain and infertility. The most common types are superficial peritoneal implants, ovarian endometriotic cysts (endometriomas), and deep-infiltrating subperitoneal lesions. Diagnosis is often delayed, and up to 65% of women are initially misdiagnosed. Imaging methods play a pivotal role in patient counseling and clinical management of the disease, and have been replacing diagnostic laparoscopy in specialized centers worldwide. Comprehensive imaging mapping is required for adequate surgical planning and to assist fertility doctors in determining the appropriate treatment options. Transvaginal ultrasound (TVU) is the first-line imaging modality and is a widely available tool that enables accurate diagnosis of endometriosis when a dedicated protocol is used. TVU is the best imaging method to investigate multiple bowel lesions and small peritoneal implants. Magnetic resonance imaging (MRI) is an excellent multiplanar method for evaluating the pelvic cavity and extrapelvic sites in endometriosis. It is the method of choice to differentiate ovarian cysts and investigate endometriosis affecting the ureters, pelvic nerves, pelvic floor, and diaphragm. This In-Depth Review describes the imaging protocol and findings of TVU and MRI to investigate endometriosis.

TVUS soft markers in clinically significant superficial endometriosis: an ultrasonographic, clinical, and laparoscopic correlation

“…Early diagnosis of endometriosis can lead to more effective treatment and an improved quality of life for affected women. Transvaginal ultrasound (TVUS) is a first-line imaging tool for assessing women with endometriosis [5][6][7] . A systematic review by the Cochrane group states that TVUS with bowel preparation has high sensitivity and specificity for diagnosing endometriomas and DIE, compared to laparoscopic results 8 .…”