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

Mee Kristine Aas-Eng; M. K. Aas‐Eng; Eliana Montanari; Marit Lieng; Joerg Keckstein; J. Keckstein; Gernot Hudelist

doi:10.1055/s-0040-1718740

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

Mee Kristine Aas-Eng, M. K. Aas‐Eng, Eliana Montanari, Marit Lieng, Joerg Keckstein, J. Keckstein, Gernot Hudelist

Seminars in reproductive medicine · 2020 · vol. 38(02/03) , pp. 216–226 · doi:10.1055/s-0040-1718740 · PMID:33232986 · W3110101452

review OA: closed CC0 ⤵ 14 in-corpus citations

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⚙ AI-generated summary by claude@2026-06, 2026-06-09 ⓘ

This review explores transvaginal sonography (TVS) and MRI for diagnosing ovarian endometriomas, deep endometriosis, and adenomyosis, emphasizing TVS as a first-line tool aligned with IDEA group recommendations.

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Abstract

Imaging 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.

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Condition tags

endometriosisadenomyosis

MeSH descriptors

Adenomyosis Endometriosis Adenomyosis Adenomyosis Adenomyosis Endometriosis Endometriosis Endometriosis Female Humans Magnetic Resonance Imaging Ovary Ovary Ovary Pelvis Pregnancy Sensitivity and Specificity Ultrasonography

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[1] Accuracy of transvaginal ultrasound for diagnosis of deep endometriosis in uterosacral ligaments, rectovaginal septum, vagina and bladder: systematic review and meta‐analysis via openalex

[2] Adenomyosis and endometriosis. Re-visiting their association and further insights into the mechanisms of auto-traumatisation. An MRI study via openalex

[3] Age-related differences in the sonographic characteristics of endometriomas via openalex

[4] A pictorial guide to the ultrasound identification and assessment of uterosacral ligaments in women with potential endometriosis via openalex

[5] A Practical Guide to the Clinical Evaluation of Endometriosis-Associated Pelvic Pain via openalex

[6] Associated ovarian endometrioma is a marker for greater severity of deeply infiltrating endometriosis via openalex

[7] Association between disease extent and pain symptoms in patients with deep infiltrating endometriosis via openalex

[8] Association between endometriosis stage, lesion type, patient characteristics and severity of pelvic pain symptoms: a multivariate analysis of over 1000 patients via openalex

[9] Association rate between deep peritoneal endometriosis and other forms of the disease: pathogenetic implications via openalex

[10] Can transvaginal sonography predict infiltration depth in patients with deep infiltrating endometriosis of the rectum? via openalex

[11] Combination of transvaginal sonography and clinical examination for preoperative diagnosis of pelvic endometriosis via openalex

[12] Combined Transvaginal/Transabdominal Pelvic Ultrasonography Accurately Predicts the 3 Dimensions of Deep Infiltrating Bowel Endometriosis Measured after Surgery: A Prospective Study in a Specialized Center via openalex

[13] Conservative treatment of rectosigmoid endometriosis: A prospective study via openalex

[14] Deep endometriosis: definition, diagnosis, and treatment via openalex

[15] Deep endometriosis infiltrating the recto-sigmoid: critical factors to consider before management via openalex

[16] Development of a clinical prediction model for diagnosing adenomyosis via openalex

[17] Diagnosis and Treatment of Bladder Endometriosis: State of the Art via openalex

[18] Diagnosis of pelvic adhesions in patients with endometrioma: the role of transvaginal ultrasonography via openalex

[19] Diagnostic accuracy and potential limitations of transvaginal sonography for bladder endometriosis via openalex

[20] Diagnostic accuracy of physical examination, transvaginal sonography, rectal endoscopic sonography, and magnetic resonance imaging to diagnose deep infiltrating endometriosis via openalex

[21] Diagnostic accuracy of transvaginal sonography for deep pelvic endometriosis via openalex

[22] Diagnostic accuracy of transvaginal ultrasound for non‐invasive diagnosis of bowel endometriosis: systematic review and meta‐analysis via openalex

[23] Diagnostic delay for endometriosis in Austria and Germany: causes and possible consequences via openalex

[24] Diagnostic delay in women with pain and endometriosis via openalex

[25] Diagnostic value of transvaginal 'tenderness-guided' ultrasonography for the prediction of location of deep endometriosis via openalex

[26] Endometriomas: their ultrasound characteristics via openalex

[27] Endometriosis MRI lexicon: consensus statement from the society of abdominal radiology endometriosis disease-focused panel via openalex

[28] Endometriosis of the ureter and bladder are not associated diseases via openalex

[29] Endometriosis on the uterosacral ligament: a marker of ureteral involvement via openalex

[30] ENZIAN-Score, eine Klassifikation der tief infiltrierenden Endometriose via openalex

[31] European society of urogenital radiology (ESUR) guidelines: MR imaging of pelvic endometriosis via openalex

[32] Evaluation of the sacral nerve plexus in pelvic endometriosis by three‐dimensional MR neurography via openalex

[33] Exploring the challenges for a new classification of adenomyosis via openalex

[34] Histopathological extent of rectal invasion by rectovaginal endometriosis via openalex

[35] How common is adenomyosis? A prospective study of prevalence using transvaginal ultrasound in a gynaecology clinic via openalex

[36] How to assess the ureters during pelvic ultrasound via openalex

[37] Imaging in gynecological disease (10): clinical and ultrasound characteristics of decidualized endometriomas surgically removed during pregnancy via openalex

[38] Imaging modalities for the non-invasive diagnosis of endometriosis via openalex

[39] Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries via openalex

[40] Impact of hospital and surgeon case volume on morbidity in colorectal endometriosis management: a plea to define criteria for expert centers via openalex

[41] Incidence of ovarian endometrioma among women with peritoneal endometriosis with and without a history of hormonal contraceptive use via openalex

[42] Informing women with endometriosis about ovarian cancer risk via openalex

[43] Is ureteral endometriosis an asymmetric disease? via openalex

[44] “Kissing ovaries”: A sonographic sign of moderate to severe endometriosis via openalex

[45] Laparoscopic management of ureteral endometriosis: A systematic review via openalex

[46] Learning curve for detection of pelvic parts of ureters by transvaginal sonography: feasibility study via openalex

[47] Learning curve for the detection of pouch of Douglas obliteration and deep infiltrating endometriosis of the rectum via openalex

[48] Management of ovarian endometriomas via openalex

[49] Natural history of ovarian endometrioma in pregnancy via openalex

[50] New Sonographic Classification of Adenomyosis: Do Type and Degree of Adenomyosis Correlate to Severity of Symptoms? via openalex

[51] Ovarian endometrioma: severe pelvic pain is associated with deeply infiltrating endometriosis via openalex

[52] Ovarian endometriosis during pregnancy: a series of 53 endometriomas via openalex

[53] Pathogenesis of uterine adenomyosis: invagination or metaplasia? via openalex

[54] Peritoneal endometriosis, ovarian endometriosis, and adenomyotic nodules of the rectovaginal septum are three different entities via openalex

[55] Preoperative Ultrasound Indications Determine Excision Technique for Bowel Surgery for Deep Infiltrating Endometriosis: A Single, High-Volume Center via openalex

[56] Preoperative work-up for patients with deeply infiltrating endometriosis: transvaginal ultrasonography must definitely be the first-line imaging examination via openalex

[57] Prevalence of Deep Endometriosis and Rectouterine Pouch Obliteration in the Presence of Normal Ovaries via openalex

[58] Progression of deep infiltrating rectosigmoid endometriotic nodules via openalex

[59] Proposed technique to visualize and classify uterosacral ligament deep endometriosis with and without infiltration into parametrium or torus uterinus via openalex

[60] Recommendations for the surgical treatment of endometriosis. Part 2: deep endometriosis†‡¶ via openalex

[61] Rectovaginal Septum Endometriosis via openalex

[62] Retrocervical, Rectovaginal Pouch, and Rectovaginal Septum Endometriosis via openalex

[63] REVIEW: Accuracy of laparoscopy in the diagnosis of endometriosis: a systematic quantitative review via openalex

[64] Revised American Society for Reproductive Medicine classification of endometriosis: 1996 via openalex

[65] Risk and prognosis of ovarian cancer in women with endometriosis: a meta-analysis via openalex

[66] Should a detailed ultrasound examination of the complete urinary tract be routinely performed in women with suspected pelvic endometriosis? via openalex

[67] Sonographic classification and reporting system for diagnosing adenomyosis via openalex

[68] Sonographic evaluation of immobility of normal and endometriotic ovary in detection of deep endometriosis via openalex

[69] Sonographic features of decidualized ovarian endometriosis suspicious for malignancy via openalex

[70] Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis, including terms, definitions and measurements: a consensus opinion from the International Deep Endometriosis Analysis (IDEA) group via openalex

[71] “Tenderness-guided” transvaginal ultrasonography: a new method for the detection of deep endometriosis in patients with chronic pelvic pain via openalex

[72] Terms, definitions and measurements to describe sonographic features of myometrium and uterine masses: a consensus opinion from the Morphological Uterus Sonographic Assessment (MUSA) group via openalex

[73] The characteristic ultrasound features of specific types of ovarian pathology (Review) via openalex

[74] The pathophysiology of endometriosis and adenomyosis: tissue injury and repair via openalex

[75] The prediction of pouch of Douglas obliteration using offline analysis of the transvaginal ultrasound 'sliding sign' technique: inter- and intra-observer reproducibility via openalex

[76] The rASRM score and the Enzian classification for endometriosis: their strengths and weaknesses via openalex

[77] To determine the optimal ultrasonographic screening method for rectal/rectosigmoid deep endometriosis: Ultrasound “sliding sign,” transvaginal ultrasound direct visualization or both? via openalex

[78] Transvaginal sonographic sliding sign: accurate prediction of pouch of Douglas obliteration via openalex

[79] Transvaginal sonography vs. clinical examination in the preoperative diagnosis of deep infiltrating endometriosis via openalex

[80] Transvaginal sonography with <i>vs</i> without bowel preparation in diagnosis of rectosigmoid endometriosis: prospective study via openalex

[81] Transvaginal ultrasonography with bowel preparation is able to predict the number of lesions and rectosigmoid layers affected in cases of deep endometriosis, defining surgical strategy via openalex

[82] Transvaginal Ultrasound Can Accurately Predict the American Society of Reproductive Medicine Stage of Endometriosis Assigned at Laparoscopy via openalex

[83] Transvaginal Ultrasound for the Diagnosis of Adenomyosis: Systematic Review and Meta-Analysis via openalex

[84] Transvaginal ultrasound <i>vs</i> magnetic resonance imaging for diagnosing deep infiltrating endometriosis: systematic review and meta‐analysis via openalex

[85] Ultrasound mapping system for the surgical management of deep infiltrating endometriosis via openalex

[86] Ureteral endometriosis and loss of renal function: mechanisms and interpretations via openalex

[87] Ureteral endometriosis: a systematic review of epidemiology, pathogenesis, diagnosis, treatment, risk of malignant transformation and fertility via openalex

[88] Ureter Visualization With Transvaginal Ultrasound via openalex

[89] Uterine sliding sign: a simple sonographic predictor for presence of deep infiltrating endometriosis of the rectum via openalex

[90] What’s the delay? A qualitative study of women’s experiences of reaching a diagnosis of endometriosis via openalex

[91] W6778816176 via openalex

[92] W2134618546 via openalex

[93] W2135157153 via openalex

[94] W2137282066 via openalex

[95] W2113503124 via openalex

[96] W2110474031 via openalex

[97] W2100503022 via openalex

[98] W2099878111 via openalex

[99] W2154095911 via openalex

[100] W2092060502 via openalex