Ultrasound Diagnosis of Pelvic Endometriosis

2011 ◽  
Vol 3 (2) ◽  
pp. 105-119
Author(s):  
Antonio Maiorana ◽  
Domenico Incandela ◽  
Laura Giambanco ◽  
Walter Alio ◽  
Luigi Alio
Keyword(s):  
Imaging Techniques ◽  
Diagnostic Technique ◽  
Ultrasound Diagnosis ◽  
Transvaginal Sonography ◽  
Anatomical Location ◽  
Deep Infiltrating Endometriosis ◽  
Pelvic Endometriosis ◽  
First Line ◽  
Intestinal Endometriosis ◽  
Deep Endometriosis

Purpose Endometriosis remains a challenging condition for clinicians, research scientists, and patients alike. Routine clinical examination is insufficient to diagnose and evaluate the extent of pelvic endometriosis which can be assessed by means of imaging techniques, including transvaginal sonography (TVS), transrectal sonography (TRS), rectal endoscopic sonography (RES), and magnetic resonance imaging (MRI). Our purpose was to analyze the different imaging techniques and their efficacy for the ultrasound diagnosis of pelvic endometriosis. Materials and methods This review examined 85 studies on the ultrasound diagnosis of endometriosis published between 2005 and 2010. The structure of the review is based first on the anatomical location of the endometriosis lesion, and then on the study of the techniques used, including transvaginal sonography, transrectal sonography, rectal endoscopic sonography, and MRI. Results TVS is the first-line imaging technique for diagnosing pelvic endometriosis. Many studies have demonstrated that sensitivities and specificities of TVS for diagnosing endometriomas range from 75% to 91% and 88% to 99%, respectively, while for RES the percentages are 88% and 90%, respectively, for the diagnosis of intestinal endometriosis. TVS and RES can correctly diagnose posterior deep infiltrating endometriosis (DIE) with an accuracy of 86.4% and 74.1%, respectively. Conclusions The analysis of these results show that ultrasound is the first-line diagnostic technique for the diagnosis of pelvic endometriosis. RES can help to identify the presence and the degree of wall infiltration of bowel sites. However, in patients with a consistent clinical suspicion of deep endometriosis, MRI is a good “all in one” examination to diagnose and define the exact extent of DIE.

scholarly journals Sonographic Differential Diagnosis in Deep Infiltrating Endometriosis: The Bowel

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Marco Scioscia ◽  
Simone Orlandi ◽  
Giamberto Trivella ◽  
Antonella Portuese ◽  
Stefano Bettocchi ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Case Series ◽  
Secondary Level ◽  
Deep Infiltrating Endometriosis ◽  
Pelvic Endometriosis ◽  
Pelvic Ultrasound ◽  
First Line ◽  
Deep Endometriosis ◽  
Operator Experience ◽  
Colonic Involvement

Up to one-third of fertile-age women with severe endometriosis suffer from colonic involvement. Transvaginal ultrasonography has become a first-line diagnostic tool for the study of the pelvis and more specifically for the diagnosis of pelvic endometriosis. Accuracy of pelvic ultrasound for deep endometriosis increases with operator experience, but the difficulties in the differential diagnosis with diseases that can afflict the bowel tract remain a challenge. We reviewed noteworthy cases referred for secondary level diagnosis suspected of bowel endometriosis in which the subsequent ultrasound led to an alternative diagnosis. This case series aims to highlight awareness for both experts and less-experienced operators the possible differential diagnoses of bowel lesions that initially resemble endometriosis.

scholarly journals Virtual cystoscopy and colonoscopy to assess deep infiltrating endometriosis

2019 ◽  
Vol 11 (1) ◽  
pp. 3-6 ◽  
Author(s):  
Emmanuel Rault ◽  
Charles-André Philip ◽  
Marion Cortet ◽  
Gil Dubernard
Keyword(s):  
Virtual Colonoscopy ◽  
Bladder Wall ◽  
Detection Threshold ◽  
Three Dimensional ◽  
Transvaginal Sonography ◽  
Deep Infiltrating Endometriosis ◽  
First Line ◽  
Virtual Cystoscopy ◽  
3D Acquisition ◽  
Infiltrating Endometriosis

Introduction: Faced with a suspicion of endometriosis, transvaginal sonography is the first-line procedure to diagnose deep infiltrating endometriosis. Methods: We recently introduced the FlyThru® mode from TOSHIBA aplio 500. With the 3D acquisition (Multiplanar Reconstruction), we can assess the deep invasion of the endometriosis nodule into the digestive and bladder wall and provide a virtual colonoscopy or cystoscopy. The entire wall of the organ can be explored either by starting the animation or by rotating the arrow. The detection threshold can be adjusted manually from 45 to 100 in order to remove any artifacts. Results: We reported two deep infiltrating endometriosis nodules explored with FlyThru mode: the first one in the rectum and the second in the bladder. Similar to a colonoscopy, the virtual animation of the FlyThru mode showed the progression into the intestine lumen until the visualization of the bulge of the nodule. Operators can appreciate precisely the location, the degree of stenosis, and the circumferential involvement of the bowel wall. The bulges of the two nodules were also visible into the bladder. The size of the lesions was assessed and related to bladder volume, which represents important preoperative data. Conclusion: Three dimensional-transvaginal sonography combined with the FlyThru mode allows the enhanced practitioner to diagnose and assess the invasion of an endometriosis nodule in a single procedure.

scholarly journals Transvaginal ultrasound in deep endometriosis: pictorial essay

2019 ◽  
Vol 52 (5) ◽  
pp. 337-341 ◽  
Author(s):  
Jorge Gilmar Amaral de Oliveira ◽  
Vanessa Bonfada ◽  
Janice de Fátima Pavan Zanella ◽  
Janaina Coser
Keyword(s):  
Preoperative Planning ◽  
Low Cost ◽  
Transvaginal Ultrasound ◽  
Standard Test ◽  
Pelvic Endometriosis ◽  
First Line ◽  
Deep Endometriosis ◽  
Gold Standard Test ◽  
Pictorial Essay ◽  
Deep Pelvic Endometriosis

Abstract Endometriosis is characterized by the presence of endometrial tissue outside the uterus. When endometrial implants penetrate more than 5 mm into the peritoneum, the condition is referred to as deep pelvic endometriosis. Although laparoscopy is the gold standard test to establish a diagnosis of deep endometriosis, transvaginal ultrasound represents an alternative that can contribute to detection of the disease, because it is an accessible, low-cost, noninvasive examination that allows preoperative planning in cases requiring surgical treatment. However, in clinical practice, transvaginal ultrasound is still not widely used as the first-line examination in suspected cases of endometriosis. This essay describes the findings of deep endometriosis on transvaginal ultrasound, in order to disseminate knowledge of the utility of the technique for the diagnosis of this disease.

scholarly journals Full-Thickness Excision versus Shaving by Laparoscopy for Intestinal Deep Infiltrating Endometriosis: Rationale and Potential Treatment Options

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Antonio Simone Laganà ◽  
Salvatore Giovanni Vitale ◽  
Maria Antonietta Trovato ◽  
Vittorio Italo Palmara ◽  
Agnese Maria Chiara Rapisarda ◽  
...  
Keyword(s):  
Uterine Cavity ◽  
Laparoscopic Approach ◽  
Deep Infiltrating Endometriosis ◽  
Full Thickness ◽  
Intestinal Endometriosis ◽  
Deep Endometriosis ◽  
Uterosacral Ligaments ◽  
Intestinal Involvement ◽  
Full Thickness Excision ◽  
Infiltrating Endometriosis

Endometriosis is defined as the presence of endometrial mucosa (glands and stroma) abnormally implanted in locations other than the uterine cavity. Deep infiltrating endometriosis (DIE) is considered the most aggressive presentation of the disease, penetrating more than 5 mm in affected tissues, and it is reported in approximately 20% of all women with endometriosis. DIE can cause a complete distortion of the pelvic anatomy and it mainly involves uterosacral ligaments, bladder, rectovaginal septum, rectum, and rectosigmoid colon. This review describes the state of the art in laparoscopic approach for DIE with a special interest in intestinal involvement, according to recent literature findings. Our attention has been focused particularly on full-thickness excision versus shaving technique in deep endometriosis intestinal involvement. Particularly, the aim of this paper is clarifying from the clinical and methodological points of view the best surgical treatment of deep intestinal endometriosis, since there is no standard of care in the literature and in different surgical settings. Indeed, this review tries to suggest when it is advisable to manage the full-thickness excision or the shaving technique, also analyzing perioperative management, main complications, and surgical outcomes.

Transvaginal Sonographic Imaging and Associated Techniques for Diagnosis of Ovarian, Deep Endometriosis, and Adenomyosis: A Comprehensive Review

2020 ◽  
Vol 38 (02/03) ◽  
pp. 216-226
Author(s):  
Mee Kristine Aas-Eng ◽  
Eliana Montanari ◽  
Marit Lieng ◽  
Joerg Keckstein ◽  
Gernot Hudelist
Keyword(s):  
Tertiary Care ◽  
Transvaginal Sonography ◽  
Imaging Method ◽  
First Line ◽  
Deep Endometriosis ◽  
Delay In Diagnosis ◽  
Line Imaging ◽  
Magnetic Resonance Imaging Mri ◽  
Ovarian Endometriomas ◽  
Sonographic Imaging

AbstractImaging of endometriosis and in particular deep endometriosis (DE) is crucial in the clinical management of women facing this debilitating condition. Transvaginal sonography (TVS) is the first-line imaging method and magnetic resonance imaging (MRI) may provide supplemental information. However, the delay in diagnosis of up to 10 years and more is of concern. This problem might be overcome by simple steps using imaging with emphasis on TVS and referral to tertiary care. Finally, TVS is crucial in mapping extent and location of disease in planning surgical therapy and counseling women regarding various therapeutic options. This review presents the available data on imaging of endometriosis with a focus on TVS and MRI for DE, adenomyosis, and ovarian endometriomas including endometriomas in pregnancy as well as the use of “soft markers.” The review presents an approach that is in accordance with the International Deep Endometriosis Analysis (IDEA) group consensus statement.

scholarly journals Diagnosis and treatment of deep infiltrating endometriosis with bowel involvement: A case report

2011 ◽  
Vol 139 (7-8) ◽  
pp. 531-535 ◽  
Author(s):  
Radmila Sparic ◽  
Gernot Hudelist ◽  
Joerg Keckstein
Keyword(s):  
Transvaginal Ultrasound ◽  
Laparoscopic Approach ◽  
Transvaginal Sonography ◽  
Deep Infiltrating Endometriosis ◽  
Deep Endometriosis ◽  
Fertility Sparing ◽  
Bowel Involvement ◽  
Surgical Teams ◽  
Histological Confirmation ◽  
Infiltrating Endometriosis

Introduction. Deep infiltrating endometriosis is a form of endometriosis penetrating deeply under the peritoneal surface causing pain and infertility. Assessment of the pelvis by laparoscopy and histological confirmation of the disease is considered the golden standard of diagnosis. Case Outline. We are presenting a patient diagnosed with deep infiltrating endometriosis by transvaginal ultrasound and treated with minimally invasive radical surgery including segmental resection of the bowel. Conclusion. Transvaginal sonography has an important role in detecting deep endometriosis of the pelvis. Fertility sparing surgery is the treatment of choice in symptomatic women wishing to retain fertility, since drugs used for endometriosis interfere with ovulation. The success of the surgery depends on the accuracy of the preoperative diagnosis. A multidisciplinary approach in managing deep endometriosis is mandatory in order to offer patients the best possible treatment using the combined skills of the colorectal and gynaecologic surgical teams. The presented case exhibits the feasibility of laparoscopic approach to severe pelvic endometriosis with bowel involvement.

scholarly journals Intra- and interobserver reproducibility of pelvic ultrasound for the detection and measurement of endometriotic lesions

2020 ◽  
Vol 2020 (2) ◽  
Author(s):  
E Bean ◽  
P Chaggar ◽  
N Thanatsis ◽  
W Dooley ◽  
C Bottomley ◽  
...  
Keyword(s):  
Transvaginal Ultrasound ◽  
Separate Analysis ◽  
Pelvic Endometriosis ◽  
Pelvic Ultrasound ◽  
First Line ◽  
Deep Endometriosis ◽  
Nodule Size ◽  
Good Level ◽  
Intraobserver Reproducibility ◽  
Level Of Agreement

Abstract STUDY QUESTION What is the interobserver and intraobserver reproducibility of pelvic ultrasound for the detection of endometriotic lesions? SUMMARY ANSWER Pelvic ultrasound is highly reproducible for the detection of pelvic endometriotic lesions. WHAT IS KNOWN ALREADY Transvaginal ultrasound (TVS) has been widely adopted as the first-line assessment for the diagnosis and assessment of pelvic endometriosis. Severity of endometriosis as assessed by ultrasound has been shown to have good concordance with laparoscopy (kappa 0.79). The reproducibility of TVS for assessment of ovarian mobility and pouch of Douglas obliteration using the ‘sliding sign’ has already been described in the literature. However, there is no available data in the literature to demonstrate the intraobserver repeatability of measurements for endometriotic cysts and nodules. STUDY DESIGN, SIZE, DURATION This was a prospective observational cross-sectional study conducted over a period of 12 months. We included 50 consecutive women who were all examined by two operators (A and B) during their clinic attendance. PARTICIPANTS/MATERIALS, SETTING, METHODS The study was carried out in a specialist endometriosis centre. We included all consecutive women who had ultrasound scans performed independently by two experienced operators during the same visit to the clinic. The outcomes of interest were the inter- and intraobserver reproducibility for the detection of endometriotic lesions. We also assessed repeatability of the measurements of lesion size. MAIN RESULTS AND THE ROLE OF CHANCE There was a good level of agreement between operator A and operator B in detecting the presence of pelvic endometriotic lesions (k = 0.72). There was a very good level of agreement between operators in identifying endometriotic cysts (k = 0.88) and a good level of agreement in identifying endometriotic nodules (k = 0.61). The inter- and intraobserver repeatability of measuring endometriotic cysts was excellent (intra-class correlation (ICC) ≥ 0.98). There was good interobserver measurement repeatability for bowel nodules (ICC 0.88), but the results for nodules in the posterior compartment were poor (ICC 0.41). The intraobserver repeatability for nodule size measurements was good for both operators (ICC ≥0.86). LIMITATIONS, REASONS FOR CAUTION Within this cohort, there was insufficient data to perform a separate analysis for nodule size in the anterior compartment. All examinations were performed within a specialised unit with a high prevalence of deep endometriosis. Our findings may not apply to operators without intensive ultrasound training in the diagnosis of pelvic endometriosis. WIDER IMPLICATIONS OF THE FINDINGS These findings are important because ultrasound has been widely accepted as the first-line investigation for the diagnosis of pelvic endometriosis, which often determines the need for future investigations and treatment. The detection and measurement of bowel nodules is essential for anticipation of surgical risk and planning surgical excision. STUDY FUNDING/COMPETING INTEREST(S) The authors have no conflict of interest. No funding was obtained for this work.

scholarly journals How to Evaluate Adenomyosis in Patients Affected by Endometriosis?

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Nadine Di Donato ◽  
Renato Seracchioli
Keyword(s):  
Demographic Data ◽  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding ◽  
Ultrasound Diagnosis ◽  
Deep Infiltrating Endometriosis ◽  
Previous Surgery ◽  
Deep Endometriosis ◽  
Question Mark ◽  
History Of ◽  
Infiltrating Endometriosis

Objective. The aim of the study is to evaluate adenomyosis in patients undergoing surgery for different type of endometriosis. It is an observational study including women with preoperative ultrasound diagnosis of adenomyosis. Demographic data and symptoms were recorded (age, body mass index, parity, history of previous surgery, dysmenorrhea, dyspareunia, dyschezia, dysuria, and abnormal uterine bleeding). Moreover a particular endometrial shape “question mark sign” linked to the presence of adenomyosis was assessed.Results. From 217 patients with ultrasound diagnosis of adenomyosis, we found 73 with ovarian histological confirmation of endometriosis, 92 with deep infiltrating endometriosis, and 52 patients who underwent surgery for infertility. Women with adenomyosis alone represented the oldest group of patients (37.8±5.18years,P=0.02). Deep endometriosis patients were nulliparous more frequently (P<0.0001), had history of previous surgery (P=0.004), and complained of more intense pain symptoms than other groups. Adenomyosis alone was significantly associated with abnormal uterine bleeding (P<0.0001). The question mark sign was found to be strongly related to posterior deep infiltrating endometriosis (P=0.01).Conclusion. Our study confirmed the strong relationship between adenomyosis and endometriosis and evaluated demographic aspects and symptoms in patients affected by different type of endometriosis.

Non-radioactive imaging strategies for in vivo immune cell tracking

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Łukasz Kiraga ◽  
Paulina Kucharzewska ◽  
Damian Strzemecki ◽  
Tomasz P. Rygiel ◽  
Magdalena Król
Keyword(s):  
Diagnostic Imaging ◽  
Contrast Agents ◽  
Cell Tracking ◽  
Immune Cell ◽  
Imaging Techniques ◽  
Diagnostic Technique ◽  
Cell Labeling ◽  
X Ray Imaging ◽  
Disease Study

Abstract In vivo tracking of administered cells chosen for specific disease treatment may be conducted by diagnostic imaging techniques preceded by cell labeling with special contrast agents. The most commonly used agents are those with radioactive properties, however their use in research is often impossible. This review paper focuses on the essential aspect of cell tracking with the exclusion of radioisotope tracers, therefore we compare application of different types of non-radioactive contrast agents (cell tracers), methods of cell labeling and application of various techniques for cell tracking, which are commonly used in preclinical or clinical studies. We discuss diagnostic imaging methods belonging to three groups: (1) Contrast-enhanced X-ray imaging, (2) Magnetic resonance imaging, and (3) Optical imaging. In addition, we present some interesting data from our own research on tracking immune cell with the use of discussed methods. Finally, we introduce an algorithm which may be useful for researchers planning leukocyte targeting studies, which may help to choose the appropriate cell type, contrast agent and diagnostic technique for particular disease study.

scholarly journals Effectiveness of ovarian suspension in preventing postoperative ovarian adhesions in patients with severe pelvic endometriosis—a case-control study

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Zahra Dehbashi ◽  
Shaheen Khazali ◽  
Fateme Davari Tanha ◽  
Farnaz Mottahedian ◽  
Mahsa Ghajarzadeh ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Transvaginal Ultrasound ◽  
Stage Iv ◽  
Clinical Pregnancy ◽  
Reproductive Age ◽  
Deep Infiltrating Endometriosis ◽  
Pelvic Endometriosis ◽  
Double Blind ◽  
Entire Study

Abstract Background Endometriosis can exert obvious negative effects on women’s quality of life. Excisional surgery is among the most effective treatments for severe pelvic endometriosis. The prevalence of severe pelvic adhesions following a laparoscopic examination of severe endometriosis varies between 50 and 100%. Temporary intraoperative ovarian suspension is a method for the reduction of adhesions is in the treatment of severe pelvic endometriosis. Given the importance and the prevalence of endometriosis and its complications, we conducted the present study to determine more effective adhesion-reducing methods with a view to improving the quality of the treatments provided. Methods The present prospective double-blind randomized clinical trial was conducted on 50 women of reproductive age (≥ 19 years) diagnosed with severe pelvic endometriosis on transvaginal ultrasound scans and vaginal examinations at Yas Hospital between 2014 and 2017. Women with severe endometriosis (stage III, stage IV, and deep infiltrating endometriosis) requiring an extensive bilateral dissection of the pelvic walls and the rectovaginal space, with preserved uterus and ovaries, were included in the study. The preoperative severity of ovarian adhesions was assessed in terms of ovarian motility, measured through a combination of gentle pressures applied with the vaginal probe and abdominal pressures applied with the examiner’s free hand. A table of random numbers was used to choose which ovary to suspend. The entire study population received standard general anesthesia. In the laparoscopic examination of the cases with severe endometriosis, both ovaries were routinely suspended to the anterior abdominal wall with PROLENE sutures. At the end of the surgery, one of the ovaries was kept suspended for 7 days, whereas the other ovarian suspension suture was cut. At 3 months postoperatively, all the patients underwent ultrasound scans for the assessment of ovarian motility and adhesions. The severity of pelvic pain was defined according to a visual analog score. After surgery, infertile women were followed for 2-4 years, and were contacted regarding the infertility treatment. Chemical and clinical pregnancy rates was compered between the two groups. Results Three months after laparoscopy, the adhesions were mild in 41 (82%) patients and moderate in 9 (18%) on the suspended side, and mild in 12 (24%) patients and moderate in 38 (76%) on the control side (P < 0.001). The mean dysmenorrhea score was 6.8 ± 1.5 before surgery and 4.5 ± 1.4 after surgery (P < 0.001). The chemical pregnancy rate and clinical pregnancy rate were not different in the suspended and control groups (P = 0. 62, P = 0.64). Conclusions The reduction in adhesions via ovarian suspension surgery promises reductions in the complications of endometriosis.

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