{"paper_id":"7dd31569-7b5f-45cb-b82e-da3d90c6ff6e","body_text":"ECR 2025 / C-22127\nStep-by-step endometriosis for radiologists: where to look in ultrasonography\nCongress:\nECR 2025\nPoster Number:\nC-22127\nType:\nEducational Exhibit\nKeywords:\nGenital / Reproductive system female, Ultrasound, Education, Pelvic floor dysfunction\nAuthors:\nB. J. B. D. Lacerda, Y. Lacerda Costa, D. A. D. P. Gonçalves Filho, P. A. Prado Mota, M. L. Ferreira Morais, C. D. Jordao, W. Lôres Filho, F. Andrade de Paula\nDOI:\n10.26044/ecr2025/C-22127\nLearning objectives\nThis study aims to review the most common locations, normal patterns, anatomy, and key findings in ultrasound for detecting deep endometriosis. The goal is to guide radiologists on where to look during examinations, ensuring greater accuracy in detecting the disease.\nBackground\nEndometriosis affects approximately 5% to 10% of women of reproductive age [2] and is a chronic, oestrogen-dependent inflammatory gynaecological disease. It is characterised by the growth of tissue similar to the endometrium outside the uterus, potentially affecting organs such as the ovaries, intestines, bladder, and diaphragm. The main symptoms include: chronic pelvic pain, infertility, pain during sexual intercourse, cyclical pain in various locations, associated urinary and bowel symptoms [1,2,5,6,7]. The diagnosis of endometriosis is often delayed, with an estimated interval of over 7 years between...\nFindings and procedure details\nUltrasound assessment for detecting deep endometriosis should follow a systematic and standardised approach, ensuring that all relevant areas are evaluated. Below is a detailed step-by-step guide:\nUterine serosa and retrocervical space assessment\nObjective: detect deep endometriosis foci near the uterus.How to perform: assess the posterior uterine serosa, paying attention to the space between the cervix and rectum. Look for hypoechoic nodules or fibrotic thickening with irregular borders. The presence of hypovascularisation or adhesions may suggest active implants. [Figures: 1, 2, and 5].\nRelative positioning of...\nConclusion\nDeep endometriosis may be underdiagnosed if radiologists do not perform a systematic and detailed assessment during transvaginal ultrasound. Standardising the examination may help prevent diagnostic errors and facilitate early detection of the disease. Transvaginal ultrasound is the first examination requested by gynaecologists when clinical suspicion of endometriosis arises. It is considered a second-line approach for preoperative mapping, particularly in detecting endometriomas and intestinal involvement. It can be enhanced with advanced techniques, increasing sensitivity without compromising the total examination time. A good ultrasound technique, combined with...\nPersonal information and conflict of interest\nB. J. B. D. Lacerda:\nNothing to disclose\nY. Lacerda Costa:\nNothing to disclose\nD. A. D. P. Gonçalves Filho:\nNothing to disclose\nP. A. Prado Mota:\nNothing to disclose\nM. L. Ferreira Morais:\nNothing to disclose\nC. D. Jordao:\nNothing to disclose\nW. Lôres Filho:\nNothing to disclose\nF. Andrade de Paula:\nNothing to disclose\nReferences\nHorne, A. W., Missmer, S.A. Pathophysiology, diagnosis, and management of endometriosis. BMJ. 2022 Nov. https://doi.org/10.1136/bmj-2022-070750.\nAdilbayeva, A., Kunz, J. Pathogenesis of Endometriosis and Endometriosis-Associated Cancers. Int J Mol Sci. 2024 Jul 11; 25 (14): 7624. https://doi.org/10.3390/ijms25147624.\nCollins, B. G., Ankola, A., Gola, S., & McGillen, K. L. (2019).Transvaginal US of Endometriosis: Looking Beyond the Endometrioma with a Dedicated Protocol. RadioGraphics, 39(5), 1549–1568. doi:10.1148/rg.2019190045.\nYoung, S.W., Jha, P., Chamié, L., Rodgers S., Kho, R.M., Horrow, M.M., Glanc, P., Feldman, M., Groszmann, Y., Khan, Z., Young S.L.,...","source_license":"CC0","license_restricted":false}