The accuracy of ultrasound compared to magnetic resonance imaging in the diagnosis of deep infiltrating endometriosis: A narrative review

Abstract

Endometriosis is defined as the presence of endometrium‐like epithelial cells and/or stroma located outside the uterus, generally with associated inflammatory response. Commonly located on the ovaries and peritoneum, endometriosis can also infiltrate the retroperitoneal space and pelvic organs, known as deep endometriosis (DE). This narrative review aims to compare the accuracy of transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI) for detecting deep endometriosis. A literature search was performed mid‐2021 and again in December 2022 using PubMed, SAGE and Wiley databases, and limited to studies published between 2011 and 2021. Key words deep infiltrating endometriosis, transvaginal ultrasound, magnetic resonance imaging and diagnostic accuracy identified 16 studies which addressed the aim. The authenticity and reliability were determined by the Standards for Reporting of Diagnostic Accuracy. When the studies were analysed, the diagnosis of DE mean sensitivity values ranged from 40% to 100% for TVUS and 50% to 100% for MRI. Mean specificity values ranged from 81.5% to 99.9% and 84.4% to 97.5%, respectively. This indicates that both MRI and TVUS have similarly accurate performance in the detection of DE. Endometriosis detection is possible with TVUS and MRI, however accuracy is dependent on the location and severity as well as limitations due to operator and image interpretation reliability. In the presence of a correctly performed dynamic TVUS examination for the diagnosis of DE, MRI adds little diagnostic value. Further research is recommended using a standardised protocol in a wider study of affected patients, including accurate clinical assessments for each location of endometriosis to inform the choice of imaging for that region.

The expanding role of sonography for the diagnosis of deep infiltrating endometriosis: Results of a large case series

“…A comparison of ultrasound and magnetic resonance imaging for the detection of DIE states that ultrasound is superior. 14 With the clinical experience of the authors observing symptomatic patients over a number of years, this series of cases is now described, attempting to correlate the pelvic examination of symptomatic patients with 2D/3DTVS imaging, laparoscopic visualization, and histologic verification. A series of clinical encounters with patients ultimately diagnosed with DIE is described in the present report.…”

“…Given a report suggesting the inaccuracy of this imaging modality, 13 the pathologic verification represented in these studies of sonographic identification of DIE, can be considered as contrasting evidence. A comparison of ultrasound and magnetic resonance imaging for the detection of DIE states that ultrasound is superior 14 …”

Deep endometriosis of ileocecum complicated by acute intestinal obstruction: a case report

“…It is defined as the presence of endometrium-like epithelial cells and/or stroma located outside the uterus. 1 Superficial endometriosis is defined as endometriosis affecting only the peritoneal surface or the uterine serosa; an endometrioma is an endometriotic ovarian cyst; deep endometriosis is characterized by damage to the digestive tract, rectovaginal septum, bladder, ureter, uterosacral ligaments, or diaphragmatic dome; and adenomyosis is characterized by damage to the uterine myometrium. The symptoms associated with endometriosis are varied and nonspecific, but catamenial pain is characteristic.…”