Diagnosing endometriosis in adolescents using ultrasound and MRI: A scoping review of imaging approach and implementation considerations

Maple S, S Maple, Shae Maple, R E Hosking, Hosking RE, Rachel Eleanor Hosking, Zhang Y, Y Zhang, Alison Deslandes, A Deslandes, Deslandes A, Hull ML, M L Hull, Jodie Avery, Avery JC, J C Avery
Radiography (London, England : 1995) · 2026 · vol. 32(7) , pp. 103579 · doi:10.1016/j.radi.2026.103579 · PMID:42833036 · W7220443272
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This scoping review of adolescent endometriosis imaging indicates that ultrasound and MRI primarily detect ovarian endometriomas and deep disease, while superficial disease remains poorly captured despite negative scans being common in symptomatic patients.

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Abstract

INTRODUCTION: Imaging is increasingly used for adult endometriosis, but evidence supporting adolescent imaging approaches remains unclear. This scoping review mapped evidence on imaging-based diagnosis of endometriosis in adolescents and young people, including ultrasound and MRI approaches, imaging-detected disease phenotypes, consent, acceptability, and AI-assisted imaging. METHODS: Studies involving people with suspected or confirmed endometriosis were eligible if participants were aged 14-25 years or the population was explicitly described as adolescent, teenage, youth, or young adult. Author-defined adolescent cohorts could therefore include participants younger than 14 years. MEDLINE, Embase, Scopus, CINAHL and Web of Science were searched, alongside grey literature and reference lists. Screening and extraction were completed independently in duplicate. Data were synthesised descriptively. RESULTS: Thirty-five evidence sources were included: nine primary studies and 26 secondary sources. The primary evidence base was limited, heterogeneous and mostly specialist-based. Ultrasound was the sole or initial modality in eight of nine primary studies; MRI was used in four. Imaging findings were most consistent for ovarian endometrioma and posterior deep endometriosis. Superficial disease was poorly captured, and normal imaging remained common in symptomatic cohorts. Secondary sources commonly described ultrasound-first approaches, with selective use of transvaginal ultrasound, transrectal ultrasound, or MRI. Acceptability, feasibility, consent and refusal were frequently discussed in secondary sources but rarely measured in primary studies. No adolescent-specific primary studies evaluated AI-assisted imaging. CONCLUSION: Imaging is recommended in clinical guidance for adolescent endometriosis and evaluated in selected cohorts, but the evidence remains limited, heterogeneous and largely adult-derived. IMPLICATIONS FOR PRACTICE: Imaging is an important component of adolescent endometriosis assessment. Modality choice and examination approach should be individualised through informed consent. Negative imaging should not be interpreted as excluding endometriosis, particularly superficial disease, when symptoms persist.

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