Endometriosis Diagnostic Modalities: The Sonographic Diagnosis of Deep Endometriosis

Transvaginal ultrasound (TVS) is considered the primary not invasive choice in patient assessment with suspected deep endometriosis (DE). The overall diagnostic performance of ultrasound for DIE lesions in rectosigmoid localization is good with high sensitivity and high specificity, and it was significantly higher than the overall diagnostic performance of TVS for assessing DIE in USLs, RVS, vaginal wall, and bladder. Comparing the diagnostic performance of TVS and MRI, we observed that it is similar. In 2016, the IDEA (International Deep Endometriosis Analysis) group consisting of some expert gynecological sonographers, surgeons, and radiologists have introduced a systematic sonographic approach about the assessment in women with clinical suspicion of deep endometriosis. The purpose of IDEA consensus was the standardization of terminology, definition of anatomic localizations, and measurement lesions modality. The IDEA approach counts of four systematic steps. The first step provides a routine assessment of uterus and adnexa; the principal aim is to detect adenomyosis and/or endometriomas. The second step is related the TVS “soft markers” (site specific tenderness and ovarian mobility). Third step provides the sliding sign used to assess the pouch of Douglas. The fourth step provides a systematic evaluation of the anterior and posterior compartment for the detection of endometriosis nodules. For vaginally located DE, the use of tenderness-guided ultrasound examination is recommended. In this modality, an increased amount of ultrasound gel is inserted into the transvaginal probe cover. This “standoff” technique creates a gap between the tip of the transvaginal probe and surrounding vaginal fornices. The sonovaginography is a sonographic transvaginal examination that allows a completion of the standard transvaginal ultrasound. Also rectal water-contrast transvaginal ultrasonography, the introduction of water in the rectal ampule, allows a distention of the rectal wall, thus improving the quality of sonographic images obtained. Access this chapter Tax calculation will be finalised at checkout Purchases are for personal use only Similar content being viewed by others

Exacoustos C, Manganaro L, Zupi E. Imaging for the evaluation of endometriosis and adenomyosis. Best Pract Res Clin Obstet Gynaecol. 2014;28:655–81. Guerriero S, Ajossa S, Minguez JA, Jurado M, Mais V, Melis GB, Alcazar JL. Accuracy of transvaginal ultrasound for diagnosis of deep endometriosis in uterosacral ligaments, rectovaginal septum, vagina and bladder: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2015;46:534–45. Reid S, Condous G. Endometriomas and pelvic endometriosis. In: Guerriero S, et al., editors. Managing ultrasonography in human reproduction. A pratical handbook. Springer; 2017. ACOG Committee Opinion No. 760. American College of Obstetricians and Gynecologists. Dysmenorrhea and endometriosis in the adolescent. Obstet Gynecol. 2018;132:e249–58. Linee guida per la diagnosi e il trattamento dell’endometriosi. Italian J Gynaecol Obstet. 2018;30(2). ISSN 2385–0868. Arruda MS, Petta CA, Abrão MS, Benetti-Pinto CL. Time elapsed from onset of symptoms to diagnosis of endometriosis in a cohort study of Brazilian women. Hum Reprod. 2003;18:756–9. Agarwal SK, Chapron C, Giudice LC, Laufer MR, Leyland N, Missmer SA, Singh SS, Taylor HS. Clinical diagnosis of endometriosis: a call to action. Am J Obstet Gynecol. 2019;220(354):e1–354.e12. Guerriero S, Ajossa S, Orozco R, Perniciano M, Jurado M, Melis GB, et al. Accuracy of transvaginal ultrasound for diagnosis of deep endometriosis in the rectosigmoid: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2016;47:281–9. Guerriero S, Ajossa S, Minguez JA, Jurado M, Mais V, Melis GB, et al. Accuracy of transvaginal ultrasound for diagnosis of deep endometriosis in uterosacral ligaments, rectovaginal septum, vagina and bladder: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2015;46:534–45. Guerriero S, Saba L, Pascual MA, Ajossa S, Rodriguez I, Mais V, et al. Transvaginal ultrasound vs magnetic resonance imaging for diagnosing deep infiltrating endometriosis: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2018;51:586–95. Guerriero S, Condous G, van den Bosch T, Valentin L, Leone FP, Van Schoubroeck D, et al. 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;48:318–32. Di Donato N, Bertoldo V, Montanari G, Zannoni L, Caprara G, Seracchioli R. Question mark form of uterus: a simple sonographic sign associated with the presence of adenomyosis. Ultrasound Obstet Gynecol. 2015;46:126–7. Kunz G, Beil D, Huppert P, Noe M, Kissler S, Leyendecker G. Adenomyosis in endometriosis—prevalence and impact on fertility. Evidence from magnetic resonance imaging. Hum Reprod. 2005;20(8):2309–16. Votino A, Van den Bosch T, Installé A, Van Schoubroeck D, Kaijser J, Kacem Y, De Moor B, Van Pachterbeke C, Timmerman D. Optimizing the ultrasound visualization of the endometrial-myometrial junction (EMJ). Facts Views Vis Obgyn. 2015;7(1):60–3. Van den Bosch T. Adenomyosis and fibroids. In: Guerriero S, et al., editors. Managing ultrasonography in human reproduction. A pratical handbook. Springer; 2017. Reid S, Lu C, Condous G. Can we improve the prediction of pouch of Douglas obliteration in women with suspected endometriosis using ultrasound based models? A multicenter prospective observational study. Acta Obstet Gynecol Scand. 2015;94(12):1297–306. Kupfer MC, Schwimer SR, Lebovic J. Transvaginal sonographic appearance of endometrioma: spectrum of findings. J Ultrasound Med. 1992;11:129–33. Van Holsbeke C, Van Calster B, Guerriero S, Savelli L, Paladini D, Lissoni AA, Czekierdowski A, Fischerova D, Zhang J, Mestdagh G, Testa AC, Bourne T, Valentin L, Timmerman D. Endometriomas: their ultrasound characteristics. Ultrasound Obstet Gynecol. 2010;35:730–40. Hudelist G, Fritzer N, Staettner S, Tammaa A, Tinelli A, Sparic R, et al. Uterine sliding sign: a simple sonographic predictor for presence of deep infiltrating endometriosis of the rectum. Ultrasound Obstet Gynecol. 2013;41:692–5. Alcázar JL. Ovarian endometriosis. In: Guerriero S, Condous G, Alcázar JL, editors. How to perform ultrasonography in endometriosis. Berlin: Springer; 2018. p. 47–55. Guerriero S, Ajossa S, Garau N, Alcazar JL, Mais V, Melis GB. Diagnosis of pelvic adhesions in patients with endometrioma: the role of transvaginal ultrasonography. Fertil Steril. 2010;94:742–6. Pascual MA, Guerriero S, Hereter L, Barri-Soldevila P, Ajossa S, Graupera B, et al. Diagnosis of endometriosis of the rectovaginal septum using introital three-dimensional ultrasonography. Fertil Steril. 2010;94:2761–5. Hudelist G, Fritzer N, Staettner S, Tammaa A, Tinelli A, Sparic R, et al. Uterine sliding sign: a simple sonographic predictor for presence of deep infiltrating endometriosis of the rectum. Ultrasound Obstet Gynecol. 2013;41:692–5. Reid S, Lu C, Casikar I, Reid G, Abbott J, Cario G, et al. Prediction of pouch of Douglas obliteration in women with suspected endometriosis using a new real-time dynamic transvaginal ultrasound technique: the sliding sign. Ultrasound Obstet Gynecol. 2013;41:685–91. Guerriero S, Ajossa S, Gerada M, D’Aquila M, Piras B, Melis GB. “Tenderness-guided” transvaginal ultrasonography: a new method for the detection of deep endometriosis in patients with chronic pelvic pain. Fertil Steril. 2007;88:1293–7. Guerriero S, Saba L, Ajossa S, Peddes C, Angiolucci M, Perniciano M, et al. Three-dimensional ultrasonography in the diagnosis of deep endometriosis. Hum Reprod. 2014;29:1189–98. Ferrero S, Scala C, Stabilini C, Vellone VG, Barra F, Maggiore LR, U. Transvaginal sonography with vs without bowel preparation in diagnosis of rectosigmoid endometriosis: prospective study. Ultrasound Obstet Gynecol. 2019;53:402–9. Noventa M, Saccardi C, Litta P, Vitagliano A, D’Antona D, Abdulrahim B, et al. Ultrasound techniques in the diagnosis of deep pelvic endometriosis: algorithm based on a systematic review and meta-analysis. Fertil Steril. 2015;104:366–83. Piessens S, Healey M, Maher P, Tsaltas J, Rombauts L. Can anyone screen for deep infiltrating endometriosis with transvaginal ultrasound? Aust N Z J Obstet Gynaecol. 2014;54:462–8. Eisenberg VH, Alcazar JL, Arbib N, Schiff E, Achiron R, Goldenberg M, et al. Applying a statistical method in transvaginal ultrasound training: lessons from the learning curve cumulative summation test (LC-CUSUM) for endometriosis mapping. Gynecol Surg. 2017;14(19) Guerriero S, Pascual MA, Ajossa S, Rodriguez I, Zajicek M, Rolla M, Llop Rams N, Yulzari V, Bardin R, Buonomo F, Comparetto O, Perniciano M, Saba S, Mais V, Alcazar JL. Learning curve for the ultrasonographic diagnosis of deep endometriosis using a structured off-line training program. Ultrasound Obstet Gynecol. 2018; https://doi.org/10.1002/uog.20176. Kavallaris A, Kohler C, Kuhne-Heid R, Schneider A. Histopathological extent of rectal invasion by rectovaginal endometriosis. Hum Reprod. 2003;18(6):1323–7. Bouaziz J, Soriano D. Complications of colorectal resection for endometriosis. Minerva Ginecol. 2017;69(5):477–87. Saccardi C, Cosmi E, Borghero A, Tregnaghi A, Dessole S, Litta P. Comparison between transvaginal sonography, saline contrast sonovaginography and magnetic resonance imaging in the diagnosis of posterior deep infiltrating endometriosis. Ultrasound Obstet Gynecol. 2012;40:464–9. Reid S, Lu C, Hardy N, Casikar I, Reid G, Cario G, Chou D, Almashat D, Condous G. Office gel sonovaginography for the prediction of posterior deep infiltrating endometriosis: a multicenter prospective observational study. Ultrasound Obstet Gynecol. 2014;44:710–8. Ferrero S, Leone Roberti Maggiore U, Barra F, Scala C. Modified ultrasonographic techniques. In: How to perform ultrasonography in endometriosis. Berlin: Springer. p. 137–9. Guerriero S, Alcázar JL, Ajossa S, Pilloni M, Melis GB. Three-dimensional sonographic characteristics of deep endometriosis. J Ultrasound Med. 2009;28:1061–6. Moura APC, Ribeiro HSAA, Bernardo WM, Simões R, Torres US, D’Ippolito G, Bazot M, Ribeiro PAAG. Accuracy of transvaginal sonography versus magnetic resonance imaging in the diagnosis of rectosigmoid endometriosis: systematic review and metaanalysis. PLoS One. 2019;14:e0214842. Piessens S. Is it time to include assessment of the most common gynaecological condition in the routine ultrasound evaluation of the pelvis? Australas J Ultrasound Med. 2019;22:83–5. Author information Authors and Affiliations Corresponding author Editor information Editors and Affiliations Rights and permissions Copyright information © 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG About this chapter Cite this chapter Guerriero, S. et al. (2022). Endometriosis Diagnostic Modalities: The Sonographic Diagnosis of Deep Endometriosis. In: Oral, E. (eds) Endometriosis and Adenomyosis. Springer, Cham. https://doi.org/10.1007/978-3-030-97236-3_9 Download citation DOI: https://doi.org/10.1007/978-3-030-97236-3_9 Published: Publisher Name: Springer, Cham Print ISBN: 978-3-030-97235-6 Online ISBN: 978-3-030-97236-3 eBook Packages: MedicineMedicine (R0)