Ultrasound evaluation of deeply infiltrative endometriosis: technique and interpretation

Endometriosis is a common benign gynecological condition defined as the presence of endometrial tissue located outside the uterus and frequently associated with chronic pelvic pain and infertility. It is a polymorphic disease that can be presented as superficial implants, endometriomas and deep lesions that infiltrate the peritoneal surface associated with fibrosis and inflammatory reaction. Diagnosis of deep endometriosis is difficult and delayed, frequently missed in a routine ultrasound. Transvaginal ultrasound is the first-line imaging modality to investigate endometriosis and when performed by an expert in female pelvic imaging can provide a reliable mapping of the affected sites. Bowel preparation can be used to improve the detection of bowel lesions as well as the other sites affected by eliminating artifacts. Surgery has been the mainstay to treat symptomatic endometriosis and preoperative imaging mapping is crucial for better results and to reduce residual disease. The goals of surgery include radical removal of all lesions and the restoration of normal pelvic anatomy. The author describes technical aspects and imaging interpretation of the transvaginal sonography to investigate deeply infiltrative endometriosis. Similar content being viewed by others

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Mattos LA, Goncalves MO, Andres MP, Young SW, Feldman M, Abrao MS, et al. Structured Ultrasound and Magnetic Resonance Imaging Reports for Patients with Suspected Endometriosis: Guide for Imagers and Clinicians. J Minim Invasive Gynecol. 2019. Author information Authors and Affiliations Corresponding author Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Electronic supplementary material Below is the link to the electronic supplementary material. Video 1. Assessment of the anterior compartment in the sagittal plane. (AVI 4790 kb) Video 2. Assessment of sliding sign in the anterior compartment (uterovesical region). (AVI 6972 kb) Video 3. Assessment of sliding sign in the right ovary. (MOV 1076 kb) Video 4. Assessment of the left ureteral path in a retrograde manner from the vesicouterine junction up to the adnexal region. (AVI 2413 kb) Video 5. Assessment of the left ureteral peristalsis. (MOV 1457 kb) Video 6. Assessment of the ureteral jet through power Doppler. (AVI 1493 kb) Video 8. Assessment of the posterior compartment by sliding the probe from the anterior into the posterior vaginal fornix. (AVI 7498 kb) Video 9. Assessment of the right uterosacral ligament. (AVI 6882 kb) Video 10. Assessment of the left uterosacral ligament. (AVI 4057 kb) Video 11. Assessment of the vagina. (AVI 6904 kb) Video 12. Assessment of the rectosigmoid colon. (AVI 7524 kb) Video 13. Assessment of DIE affecting the ovarian fossae and its proximity to the left ureteral path. (AVI 4556 kb) Video 14. Assessment of retrocervical DIE. (AVI 6922 kb) Video 15. Assessment of vaginal DIE associated with a right retrocervical lesion. (AVI 7452 kb) Video 16. Assessment of bowel DIE affecting the rectosigmoid colon up to the submucosal layer. (AVI 5253 kb) Rights and permissions About this article Cite this article Chamié, L.P. Ultrasound evaluation of deeply infiltrative endometriosis: technique and interpretation. Abdom Radiol 45, 1648–1658 (2020). https://doi.org/10.1007/s00261-019-02322-7 Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00261-019-02322-7