Women, endometriosis, and the evolution of imaging

<!-- Brazil - Women, endometriosis, and the evolution of imaging Women, endometriosis, and the evolution of imaging window.dataLayer = window.dataLayer || []; function gtag(){dataLayer.push(arguments);} gtag('js', new Date()); gtag('config', 'G-MKLVK7B5B6'); .articleTxt{ top: -16px; } .scielo__border-top{ border-top: 1px solid #ccc !important; } @media (max-width: 575.98px) { .articleCtt > .container{ padding-left: 0; padding-right: 0; } .articleCtt .articleTxt{ padding-left: 16px !important; padding-right: 16px !important; } } @media (min-width: 768px){ .scielo__truncate{ display: block; max-width: 285px; } } menu Menu Brazil Journal list by title Journal list by subject area Search Metrics (abre em nova aba) Sobre o SciELO Brazil Contacts Report error SciELO.org - The SciELO Network (abre em nova aba) National and thematic collections (abre em nova aba) Journal list by title (abre em nova aba) Journal list by subject (abre em nova aba) Search (abre em nova aba) Metrics (abre em nova aba) OAI and RSS (abre em nova aba) About the SciELO Network (abre em nova aba) Contacts (abre em nova aba) Blog SciELO in Perspective (abre em nova aba) document.addEventListener('DOMContentLoaded', function () { const wrapper = document.getElementById('scieloMainMenu'); const toggle = document.getElementById('scieloMainMenuToggle'); const panel = document.getElementById('scieloMainMenuNav2'); if (!wrapper || !toggle || !panel) return; const icon = toggle.querySelector('.material-icons-outlined'); const focusableSelector = [ 'a[href]', 'button:not([disabled])', 'input:not([disabled])', 'select:not([disabled])', 'textarea:not([disabled])', '[tabindex]:not([tabindex="-1"])' ].join(','); function setIcon(iconName) { if (icon) { icon.textContent = iconName; } } function getFocusableItems() { return Array.prototype.slice.call(panel.querySelectorAll(focusableSelector)) .filter(function (item) { return item.offsetParent !== null; }); } function openMenu() { panel.hidden = false; toggle.setAttribute('aria-expanded', 'true'); wrapper.classList.add('is-open'); setIcon('close'); const focusableItems = getFocusableItems(); if (focusableItems.length) { focusableItems[0].focus(); } } function closeMenu(options) { const settings = options || {}; panel.hidden = true; toggle.setAttribute('aria-expanded', 'false'); wrapper.classList.remove('is-open'); setIcon('menu'); if (settings.restoreFocus) { toggle.focus(); } } function isMenuOpen() { return toggle.getAttribute('aria-expanded') === 'true'; } toggle.addEventListener('click', function (event) { event.preventDefault(); event.stopPropagation(); if (isMenuOpen()) { closeMenu({ restoreFocus: true }); } else { openMenu(); } }); panel.addEventListener('click', function (event) { event.stopPropagation(); }); document.addEventListener('click', function (event) { if (isMenuOpen() && !wrapper.contains(event.target)) { closeMenu(); } }); document.addEventListener('keydown', function (event) { if (!isMenuOpen()) return; if (event.key === 'Escape') { event.preventDefault(); closeMenu({ restoreFocus: true }); return; } if (event.key !== 'Tab') return; const focusableItems = getFocusableItems(); if (!focusableItems.length) return; const firstItem = focusableItems[0]; const lastItem = focusableItems[focusableItems.length - 1]; if (event.shiftKey && document.activeElement === firstItem) { event.preventDefault(); toggle.focus(); return; } if (!event.shiftKey && document.activeElement === toggle) { event.preventDefault(); firstItem.focus(); return; } if (!event.shiftKey && document.activeElement === lastItem) { closeMenu(); } }); }); Brazil language en English Português Español Radiologia Brasileira Mostrar opções launch Submission of manuscripts info About the journal help_outline Política editorial people Editorial Board help_outline Instructions to authors email Contact show_chart Metrics home Table of contents navigate_before previous current next navigate_next Text (EN) Text (English) Text (Portuguese) PDF Download PDF (English) Download PDF (Portuguese) article Conteúdo: Text (EN) Text (English) Text (Portuguese) Download PDF (English) (abre em nova aba) Download PDF (Portuguese) (abre em nova aba) share Whatsapp BlueSky Mastodon Facebook Mais home Table of contents share Whatsapp BlueSky Mastodon Facebook Mais Text (EN) Text (English) Text (Portuguese) PDF Download PDF (English) (abre em nova aba) Download PDF (Portuguese) (abre em nova aba) Editorial • Radiol Bras 52 (05) • Sep-Oct 2019 • https://doi.org/10.1590/0100-3984.2019.52.5e2 link copy Women, endometriosis, and the evolution of imaging Authorship SCIMAGO INSTITUTIONS RANKINGS My first contact with endometriosis was when I was about 10 years old and I heard my mother commenting to her friends “Do you know that pain that Clarinha has had for years? They finally found out that she has something called endometriosis! The doctor said that it is very rare and means that a piece of the uterus has grown out of place . . .” I was a bit scared of that “weird disease”, and its name was stored in my memory. Until the 1990s, when laparoscopy came to be widely used, endometriosis was still relatively unknown. Laparoscopy revolutionized the diagnosis of endometriosis, and, from that time onward, understanding of the disease has increased greatly. Concomitantly, we radiologists began to walk side-by-side with gynecologists, initially in relation to the diagnosis of ovarian endometriomas, whose presentations on ultrasound became “typical”, with the famous “chocolate cysts”. Now we have become a player. How many women have benefited from these findings? Thousands! One of the first studies, published in 1989, showed that magnetic resonance imaging (MRI) has good sensitivity for the characterization of endometriomas, although it did not replace laparoscopy ( 1 ) . In 1993, the classic study conducted by Sugimura et al. ( 2 ) defined the signal behavior of endometriomas on MRI, the famous T2 shading, which defined the pattern of different shades of gray on T2-weighted images and could indicate different epochs of bleeding. In 1994, despite so many advances, endometriosis was still considered an enigma in terms of its diagnosis and its origin ( 3 ) . The evolution of imaging allowed radiologists to be protagonists in so many other diseases, so why were we still playing only a supporting role in endometriosis? It was because there was still a lack of understanding of the imaging aspects of deep endometriosis in the main imaging methods applied for pelvic assessment. Ultrasound soon proved to be the best imaging method for the evaluation of endometriosis, and, within a few years, the best examination technique and key imaging features for the assessment of deep foci had been defined. In 1985, the efficacy of ultrasound was only 10% of that of laparoscopy ( 4 ) . After the examination technique (bowel preparation, specific maneuvers, and systematic, compartmentalized evaluation) was defined, the efficacy of ultrasound rose to approximately 95% ( 5 , 6 ) . In 2009, Chapron et al. recommended that transvaginal ultrasound (TVUS) with bowel preparation be used as the first-line examination in the preoperative evaluation of patients with endometriosis ( 7 ) . In this issue of Radiologia Brasileira, there is an excellent, comprehensive article describing the presentation forms of endometriosis on TVUS with bowel preparation ( 8 ) . Although MRI evolved in parallel with ultrasound, it did so more slowly. In the early 2000s, when ultrasound was already emerging as a promising method for the evaluation of endometriosis, MRI struggled with protocol variability, equipment quality, and, consequently, image quality. As image quality improved and protocols evolved, the efficacy of MRI improved greatly, coming to equal that of TVUS, as demonstrated in a meta-analysis published in 2018 ( 9 ) . With all of this favorable evolution, imaging came to play a leading role in the evaluation of endometriosis. It has now replaced laparoscopy in the diagnosis and in the planning of treatment (clinical or surgical), as well as allowing the safe monitoring of the affected patients. REFERENCES 1 Zawin M, McCarthy S, Scoutt L, et al. Endometriosis: appearance and detection at MR imaging. Radiology. 1989;171:693-6. 2 Sugimura K, Okizuka H, Imaoka I, et al. Pelvic endometriosis: detection and diagnosis with chemical shift MR imaging. Radiology. 1993;188:435-8. 3 Thomas EJ. Endometriosis: still an enigma. Br J Obstet Gynaecol. 1993;100:615-7. 4 Friedman H, Vogelzang RL, Mendelson EB, et al. Endometriosis detection by US with laparoscopic correlation. Radiology. 1985;157:217-20. 5 Guerriero S, Saba L, Pascual MA, 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. 6 Fonseca EKUN, Bastos BB, Yamauchi FI, et al. Ruptured endometrioma: main imaging findings. Radiol Bras. 2018;51:411-2. 7 Piketty M, Chopin N, Dousset B, et al. Preoperative work-up for patients with deeply infiltrating endometriosis: transvaginal ultrasonography must definitely be the first-line imaging examination. Hum Reprod. 2009;24:602-7. 8 Oliveira JGA, Bonfada V, Zanella JFP, Coser J. Ultrassonografia transvaginal na endometriose profunda: ensaio iconográfico. Radiol Bras. 2019;52:337-41. 9 Oliveira JGA, Bonfada V, Figueiró MF, et al. Clinical features, socio-demographic profile and ultrasound findings in women with endometriosis symptoms. Sci Med. 2018;28(4):ID30496. Publication Dates Publication in this collection 24 Oct 2019 Date of issue Sep-Oct 2019 This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Authorship .author-card { border-bottom: 1px solid #ccc; padding: 1rem 0; } .author-card:last-child { border-bottom: 0px; } .author-name { font-weight: 600; } .orcid-button { padding-left: 2.5rem; } .modal-body { padding-bottom: 3rem; } .orcid-button::before { content: ""; position: absolute; background-image: url(https://ds.scielo.org/img/logo-orcid.svg); background-repeat: no-repeat; background-size: 1.5em auto; background-position: .5em center; display: block; width: 60px; height: 60px; top: -10px; left: 0; } person Suzan Menasce Goldman school Associate Professor, Department of Imaging Diagnosis, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil. E-mail: [email protected]. https://orcid.org/0000-0002-3596-3419. Universidade Federal de São Paulo Brazil São Paulo, SP, Brazil Associate Professor, Department of Imaging Diagnosis, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil. E-mail: [email protected]. https://orcid.org/0000-0002-3596-3419. 0000-0002-3596-3419 SCIMAGO INSTITUTIONS RANKINGS Associate Professor, Department of Imaging Diagnosis, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil. E-mail: [email protected]. https://orcid.org/0000-0002-3596-3419. Universidade Federal de São Paulo Brazil São Paulo, SP, Brazil Associate Professor, Department of Imaging Diagnosis, Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil. E-mail: [email protected]. https://orcid.org/0000-0002-3596-3419. How to cite link copy function currentDate() { var today = new Date(); var months = ['January', 'February', 'March', 'April', 'May', 'June', 'July', 'August', 'September', 'October', 'November', 'December'] today.setTime(today.getTime()); return today.getDate() + " " + months[today.getMonth()] + " " + today.getFullYear(); } var citation = 'Goldman, Suzan Menasce. 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