{"paper_id":"2c8e8048-f01d-4117-bf02-7b94c9ad557a","body_text":"Vol.:(0123456789)1 3\nAbdominal Radiology (2020) 45:1647 \nhttps://doi.org/10.1007/s00261-020-02552-0\nLETTER TO THE EDITOR\nResponse to Letter to the Editor. Re: Association between kissing \nand retropositioned ovaries and severity of endometriosis: MR \nimaging evaluation\nWendaline M. VanBuren1\nPublished online: 30 April 2020 \n© Springer Science+Business Media, LLC, part of Springer Nature 2020\nThis letter is in response to the letter by M. Leonardi and \nG. Condous who in response to our article [1 ], highlighted \nthe vital role of ultrasound in the assessment of endome-\ntriosis and “kissing ovaries”. The points addressed by the \nauthors are valid and noteworthy, however, several portions \nof the discussion require further clarification. In particular, \nultrasound when performed with a dedicated protocol such \nas those suggested in this edition [2, 3] and a skilled opera-\ntor may achieve excellent results. Routine pelvic ultrasound \nwhich is not targeted for endometriosis may underperform \nwhen compared to MRI for disease detection [4 ] for a vari-\nety of reasons, but certainly non-dedicated protocols, opera-\ntor/interpreter inexperience and limited field of view may \ncontribute.\nWhile “kissing ovaries” themselves are a surgical descrip-\ntor of characteristic morphologic changes related to endo-\nmetriosis, until this configuration is identifiable via other \nmodalities it remains a presumption. Both our paper and \nyour letter reference the study which validates this configu-\nration on ultrasound [5 ]. While not surprising, our study \ngoes on to validate this characteristic positioning at MRI, \nhowever, also shows that ovarian positioning has increased \ndisease severity independent of the presence or absence of \nan endometrioma and shows an increased risk of deep infil-\ntrative endometriosis.\nOur paper highlights the increased disease severity of \nendometriosis seen in association with “kissing ovaries” and \nshould prompt a thorough search pattern to optimize future \npossible operative management.\nReferences\n 1. Williams JC, Burnett TL, Jones T, Venkatesh SK, Van Buren WM \n(2019) Association between kissing and retropositioned ovaries \nand severity of endometriosis: MR imaging evaluation. Abdom \nRadiol https ://doi.org/10.1007/s0026 1-019-02153 -6\n 2. Chamié, L.P. Ultrasound evaluation of deeply infiltrative endome-\ntriosis: technique and interpretation.  Abdom Radiol (2019). https \n://doi.org/10.1007/s0026 1-019-02322 -7\n 3. Young, S.W., Groszmann, Y., Dahiya, N.  et al. Sonographer-\nacquired ultrasound protocol for deep endometriosis.  Abdom \nRadiol (2019). https ://doi.org/10.1007/s0026 1-019-02341 -4\n 4. Bartlett, D.J., Burkett, B.J., Burnett, T.L.  et al. Comparison of \nroutine pelvic US and MR imaging in patients with pathologi-\ncally confirmed endometriosis.  Abdom Radiol (2019). https ://doi.\norg/10.1007/s0026 1-019-02124 -x\n 5. Ghezzi F, Raio L, Cromi A, et al (2005) “Kissing ovaries”: A \nsonographic sign of moderate to severe endometriosis. Fertil Steril \n83:143–7. https ://doi.org/10.1016/j.fertn stert .2004.05.094\nPublisher’s Note Springer Nature remains neutral with regard to \njurisdictional claims in published maps and institutional affiliations.\nThis reply refers to the comment available online at https ://doi.\norg/10.1007/s0026 1-019-02224 -8.\nThis comment refers to the article available online at https ://doi.\norg/10.1007/s0026 1-019-02153 -6.\n * Wendaline M. VanBuren \n VanBuren.Wendaline@mayo.edu\n1 Department of Radiology, Mayo Clinic, Rochester, MN, \nUSA","source_license":"CC0","license_restricted":false}