Endometriomas on routine pelvic ultrasound (US) as an indication for MRI for deep endometriosis (DE)

Purpose To determine whether presence of endometriomas on routine pelvic ultrasound (US) can predict presence of deep infiltrating endometriosis (DE) on magnetic resonance imaging (MRI) and correlate endometrioma size with the presence of DE on MRI.

In this IRB approved, HIPAA compliant study, radiology data base was queried for MRI exams dedicated for endometriosis evaluation in patients with surgically proven endometriosis over a three-year period (2016–2019). Imaging reports were reviewed for the presence of endometriomas and DE on MRI. For the patients with endometriomas, records were reviewed for concurrent routine pelvic US imaging, which were not tailored to DE protocols. US images were reviewed for the presence of endometriomas, their total number, laterality and largest dimension. Descriptive statistics and receiver operating curve (ROC) analysis were performed. Pathology and surgical notes were used as reference standard.

253 patients with surgically confirmed endometriosis underwent MRI for DIE over a 3-year duration. 47 patients had a concurrent US exam. 33/47 patients (70.2%) had endometriomas seen on US (size range 0.9–7.0 cm). 12 had bilateral endometriomas and 13 had multiple (more than 1) endometriomas. 27/33 (82%) of these patients had DE on MRI. 6/33 (18%) patients had additional sites of DE on surgery, which was not reported preoperatively on MRI. When endometriomas more than 3 cm as were evaluated, 19/21 (90%) of patients had DE on MRI. AUC was 0.7106. Using ROC analysis, a threshold of 3.8 cm, provided a sensitivity of 71% and specificity of 78% for detection of DE on MRI.

Presence of endometriomas on routine pelvic US is associated with a high frequency of DE detected on MRI performed for endometriosis. The frequency of DE on MRI was higher in patients with endometrioma size > 3 cm compared to endometriomas of all size range. Similar content being viewed by others Data availability No datasets were generated or analysed during the current study.

Young SW, Jha P, Chamie L, Rodgers S, Kho RM, Horrow MM, Glanc P, Feldman M, Groszmann Y, Khan Z, Young SL, Poder L, Burnett TL, Hu EM, Egan S, VanBuren W. Society of Radiologists in Ultrasound Consensus on Routine Pelvic US for Endometriosis. Radiology 2024;311(1):e232191. doi: https://doi.org/10.1148/radiol.232191 VanBuren W, Feldman M, Shenoy-Bhangle AS, Sakala MD, Young S, Chamie LP, Giudice L, Hindman NM, Tong A, Rabban JT, Yano M, Kilcoyne A, Dave HD, Poder L, Kho RM, Burnett TL, Khan Z, King C, Shen L, Colak C, Burk KS, Andrieu PIC, Franco IVP, Glanc P, Kielar AZ, Taffel MT, Kania LM, Bonde A, Pectasides M, Arif-Tiwari H, Laifer-Narin S, Nicola R, Jha P. Radiology State-of-the-art Review: Endometriosis Imaging Interpretation and Reporting. Radiology 2024;312(3):e233482. doi: https://doi.org/10.1148/radiol.233482 Mowers EL, Lim CS, Skinner B, Mahnert N, Kamdar N, Morgan DM, As-Sanie S. Prevalence of Endometriosis During Abdominal or Laparoscopic Hysterectomy for Chronic Pelvic Pain. Obstet Gynecol 2016;127(6):1045–1053. doi: https://doi.org/10.1097/AOG.0000000000001422 Nezhat CR, Oskotsky TT, Robinson JF, Fisher SJ, Tsuei A, Liu B, Irwin JC, Gaudilliere B, Sirota M, Stevenson DK, Giudice LC. Real world perspectives on endometriosis disease phenotyping through surgery, omics, health data, and artificial intelligence. NPJ Womens Health 2025;3(1):8. doi: https://doi.org/10.1038/s44294-024-00052-w Jha P, Sakala M, Chamie LP, Feldman M, Hindman N, Huang C, Kilcoyne A, Laifer-Narin S, Nicola R, Poder L, Shenoy-Bhangle A, Tong A, VanBuren W, Taffel MT. Endometriosis MRI lexicon: consensus statement from the society of abdominal radiology endometriosis disease-focused panel. Abdom Radiol (NY) 2020;45(6):1552–1568. doi: https://doi.org/10.1007/s00261-019-02291-x Ellis K, Wood R. A decade to wait: Update on the average delay to diagnosis for endometriosis in Aotearoa New Zealand. Aust N Z J Obstet Gynaecol 2024. doi: https://doi.org/10.1111/ajo.13836 Soliman AM, Fuldeore M, Snabes MC. Factors Associated with Time to Endometriosis Diagnosis in the United States. J Womens Health (Larchmt) 2017;26(7):788–797. doi: https://doi.org/10.1089/jwh.2016.6003 Condous G, Gerges B, Thomassin-Naggara I, Becker C, Tomassetti C, Krentel H, van Herendael BJ, Malzoni M, Abrao MS, Saridogan E, Keckstein J, Hudelist G, Collaborators. Non-invasive imaging techniques for diagnosis of pelvic deep endometriosis and endometriosis classification systems: An International Consensus Statement. Eur J Radiol 2024;176:111450. doi: https://doi.org/10.1016/j.ejrad.2024.111450 Guerriero S, Condous G, van den Bosch T, Valentin L, Leone FP, Van Schoubroeck D, Exacoustos C, Installe AJ, Martins WP, Abrao MS, Hudelist G, Bazot M, Alcazar JL, Goncalves MO, Pascual MA, Ajossa S, Savelli L, Dunham R, Reid S, Menakaya U, Bourne T, Ferrero S, Leon M, Bignardi T, Holland T, Jurkovic D, Benacerraf B, Osuga Y, Somigliana E, Timmerman D. 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. Ultrasound Obstet Gynecol 2016;48(3):318–332. doi: https://doi.org/10.1002/uog.15955 Young SW, Dahiya N, Yi J, Wasson M, Davitt J, Patel MD. Impact of Uterine Sliding Sign in Routine United States Ultrasound Practice. J Ultrasound Med 2021;40(6):1091–1096. doi: https://doi.org/10.1002/jum.15484 Young SW, Groszmann Y, Dahiya N, Caserta M, Yi J, Wasson M, Patel MD. Sonographer-acquired ultrasound protocol for deep endometriosis. Abdom Radiol (NY) 2020;45(6):1659–1669. doi: https://doi.org/10.1007/s00261-019-02341-4 Bartlett DJ, Burkett BJ, Burnett TL, Sheedy SP, Fletcher JG, VanBuren WM. Comparison of routine pelvic US and MR imaging in patients with pathologically confirmed endometriosis. Abdom Radiol (NY) 2020;45(6):1670–1679. doi: https://doi.org/10.1007/s00261-019-02124-x Tong A, Cope AG, Waters TL, McDonald JS, VanBuren WM. Best Practices: Ultrasound Versus MRI in the Assessment of Pelvic Endometriosis. AJR Am J Roentgenol 2024;223(6):e2431085. doi: https://doi.org/10.2214/AJR.24.31085 Banerjee SK, Ballard KD, Wright JT. Endometriomas as a marker of disease severity. J Minim Invasive Gynecol 2008;15(5):538–540. doi: https://doi.org/10.1016/j.jmig.2008.05.004 Chapron C, Pietin-Vialle C, Borghese B, Davy C, Foulot H, Chopin N. Associated ovarian endometrioma is a marker for greater severity of deeply infiltrating endometriosis. Fertil Steril 2009;92(2):453–457. doi: https://doi.org/10.1016/j.fertnstert.2008.06.003 Kwok H, Jiang H, Li T, Yang H, Fei H, Cheng L, Yao S, Chen S. Lesion distribution characteristics of deep infiltrating endometriosis with ovarian endometrioma: an observational clinical study. BMC Womens Health 2020;20(1):111. doi: https://doi.org/10.1186/s12905-020-00974-y Tong A, VanBuren WM, Chamie L, Feldman M, Hindman N, Huang C, Jha P, Kilcoyne A, Laifer-Narin S, Nicola R, Poder L, Sakala M, Shenoy-Bhangle AS, Taffel MT. Recommendations for MRI technique in the evaluation of pelvic endometriosis: consensus statement from the Society of Abdominal Radiology endometriosis disease-focused panel. Abdom Radiol (NY) 2020;45(6):1569–1586. doi: https://doi.org/10.1007/s00261-020-02483-w Ruaux E, Nougaret S, Gavrel M, Charlot M, Devouassoux-Shisheboran M, Golfier F, Thomassin-Naggara I, Rousset P. Endometriosis MR mimickers: T1-hyperintense lesions. Insights Imaging 2024;15(1):19. doi: https://doi.org/10.1186/s13244-023-01587-3 Author information Authors and Affiliations Contributions PJ: collected and analyzed the data, reviewed images and wrote the main manuscript text CH: collected and analyzed the dataHC: collected and analyzed the data, prepared figures WVB: Edited manuscriptLP: Prepared figures and edited manuscriptAll authors reviewed the manuscript. Corresponding author Ethics declarations Conflict of interest The authors declare no competing interests. Additional information Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. About this article Cite this article Jha, P., Huang, C., Choi, H. et al. Endometriomas on routine pelvic ultrasound (US) as an indication for MRI for deep endometriosis (DE). Abdom Radiol 51, 255–260 (2026). https://doi.org/10.1007/s00261-025-05060-1 Received: Revised: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00261-025-05060-1