Sonographic evaluation of deep endometriosis: protocol for a US radiology practice

Endometriosis is a common condition with significant morbidity, including pain and subfertility, which is often subject to a delay in diagnosis. Ultrasound has been successfully utilized, mostly outside North America, to preoperatively stage deep endometriosis, but in these international settings, imaging is typically performed solely by expert radiologists and gynecologists. We outline a method for detailed sonographic survey of the lower abdomen and pelvis to ensure optimum detection and communication of disease extent that is geared to radiologists practicing ultrasound in the United States, with the use of diagnostic medical sonographers. Similar content being viewed by others

Eskenazi B, Warner ML (1997) Epidemiology of endometriosis. Obstet Gynecol Clin N Am 24(2):235–258 Schliep KC, et al. (2015) Pain typology and incident endometriosis. Human Reprod 30(10):2427–2438 Holland TK, et al. (2013) Ultrasound mapping of pelvic endometriosis: does the location and number of lesions affect the diagnostic accuracy? A multicentre diagnostic accuracy study. BMC women health 13:43 Reid S, et al. (2013) 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 41(6):685–691 Reid S, et al. (2014) Office gel sonovaginography for the prediction of posterior deep infiltrating endometriosis: a multicenter prospective observational study. Ultrasound Obstet Gynecol 44(6):710–718 Hudelist G, et al. (2013) Uterine sliding sign: a simple sonographic predictor for presence of deep infiltrating endometriosis of the rectum. Ultrasound Obstet Gynecol 41(6):692–695 Exacoustos C, et al. (2014) Ultrasound mapping system for the surgical management of deep infiltrating endometriosis. Fertil Steril 102(1):143–150 Goncalves MO, et al. (2010) Transvaginal ultrasonography with bowel preparation is able to predict the number of lesions and rectosigmoid layers affected in cases of deep endometriosis, defining surgical strategy. Human Rep 25(3):665–671 Nnoaham KE, et al. (2011) Impact of endometriosis on quality of life and work productivity: a multicenter study across ten countries. Fertil Steril 96(2):366–373 Doniec JM, et al. (2003) Rectal endometriosis: high sensitivity and specificity of endorectal ultrasound with an impact for the operative management. Dis Colon Rectum 46(12):1667–1673 Chapron C, Dubuisson JB (2001) Management of deep endometriosis. Ann N Y Acad Sci 943:276–280 Garry R, Clayton R, Hawe J (2000) The effect of endometriosis and its radical laparoscopic excision on quality of life indicators. Int J Obstet Gynaecol 107(1):44–54 Coccia ME, Rizzello F (2011) Ultrasonographic staging: a new staging system for deep endometriosis. Ann N Y Acad Sci 1221:61–69 Noventa M, et al. (2015) Ultrasound techniques in the diagnosis of deep pelvic endometriosis: algorithm based on a systematic review and meta-analysis. Fertil Steril 104(2):366–383 Cornillie FJ, et al. (1990) Deeply infiltrating pelvic endometriosis: histology and clinical significance. Fertil Steril 53(6):978–983 Nisolle M, Donnez J (1997) Peritoneal endometriosis, ovarian endometriosis, and adenomyotic nodules of the rectovaginal septum are three different entities. Fertil Steril 68(4):585–596 Giudice LC, Kao LC (2004) Endometriosis. Lancet 364(9447):1789–1799 Hudelist G, et al. (2009) Combination of transvaginal sonography and clinical examination for preoperative diagnosis of pelvic endometriosis. Human Reprod 24(5):1018–1024 Leon M, et al. (2014) Extended transvaginal sonography in deep infiltrating endometriosis: use of bowel preparation and an acoustic window with intravaginal gel: preliminary results. J Ultrasound Med 33(2):315–321 Benacerraf BR, et al. (2015) Deep infiltrating endometriosis of the bowel wall: the comet sign. J Ultrasound Med 34(3):537–542 Abrao MS, et al. (2007) Comparison between clinical examination, transvaginal sonography and magnetic resonance imaging for the diagnosis of deep endometriosis. Human Rep 22(12):3092–3097 Guerriero S, et al. (2015) 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 46(5):534–545 Chapron C, et al. (2010) Surgery for bladder endometriosis: long-term results and concomitant management of associated posterior deep lesions. Human Reprod 25(4):884–889 Hudelist G, et al. (2009) Can transvaginal sonography predict infiltration depth in patients with deep infiltrating endometriosis of the rectum? Human Reprod 24(5):1012–1017 Bazot, M., et al., Diagnostic accuracy of transvaginal sonography for deep pelvic endometriosis. Ultrasound Obstet Gynecol 24(2):180–185 Del Frate C, et al. (2006) Deep retroperitoneal pelvic endometriosis: MR imaging appearance with laparoscopic correlation. Radiographics 26(6):1705–1718 Chapron C, et al. (2003) Anatomical distribution of deeply infiltrating endometriosis: surgical implications and proposition for a classification. Human Reprod 18(1):157–161 Pateman K, et al. (2015) Should a detailed ultrasound examination of the complete urinary tract be routinely performed in women with suspected pelvic endometriosis? Human Reprod 30(12):2802–2807 Balthazar EJ (2000) Diseases of the appendix. In: Gore RM, Levine MS (eds) Textbook of gastrointestinal radiology. Philadelphia: W. B. Saunders Company, pp 1123–1150 Willekens I, et al. (2014) The normal appendix on CT: does size matter? PloS One 9(5):e96476 Di Donato N, et al. (2014) Prevalence of adenomyosis in women undergoing surgery for endometriosis. Eur J Obstet Gynecol Reprod Biol 181:289–293 Abrao MS, et al. (2008) Endometriosis lesions that compromise the rectum deeper than the inner muscularis layer have more than 40% of the circumference of the rectum affected by the disease. J Minim Invasive Gynecol 15(3):280–285 Wolthuis AM, et al. (2014) Bowel endometriosis: colorectal surgeon’s perspective in a multidisciplinary surgical team. World J Gastroenterol 20(42):15616–15623 Kondo W, et al. (2015) Laparoscopic double discoid resection with a circular stapler for bowel endometriosis. J Minim Invasive Gynecol 22(6):929–931 Darwish B, Roman H (2016) Surgical treatment of deep infiltrating rectal endometriosis: in favor of less aggressive surgery. Am J Obstet Gynecol 215(2):195–200 Haber HP, Stern M (2000) Intestinal ultrasonography in children and young adults: bowel wall thickness is age dependent. J Ultrasound Med 19(5):315–321 Koga K, et al. (2003) Characteristic images of deeply infiltrating rectosigmoid endometriosis on transvaginal and transrectal ultrasonography. Human Reprod 18(6):1328–1333 Ferreira MC, Carneiro MM (2010) Ultrasonographic aspects of endometriosis. J Endometr 2(2):47–54 Massein A, et al. (2013) Imaging of intestinal involvement in endometriosis. Diagn interv Imaging 94(3):281–291 Abrao MS (2012) Surgical management of deep infiltrating endometriosis. Int J Gynecol Obstet 119(Suppl 3):S161 Acknowledgments The authors acknowledge Drs. Manoel Gonçalves, Mauricio Abrão and Leandro Accardo de Mattos at Clinica Medicina da Mulher in São Paolo, Brazil for their invaluable training. Author information Authors and Affiliations Corresponding author Ethics declarations Funding This review article was unfunded. Conflict of interest The authors whose names are listed immediately below certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript. Ethical approval This article is a review article which does not contain any studies with human participants or animals performed by any of the authors. Electronic supplementary material Below is the link to the electronic supplementary material. 261_2016_886_MOESM1_ESM.avi (download AVI ) Video 1: Uterine sliding sign, normal appearance. The transducer is seated in the anterior fornix, just in front of the anterior cervical lip, adjacent to the urinary bladder. Note the sharp, smooth interface between the posterior wall of the cervix and the bowel and retrocervical adipose deep to the cervix and uterine body. Free motion is evident during ballottement (AVI 9067 KB). 261_2016_886_MOESM2_ESM.avi (download AVI ) Video 2: Uterine sliding sign, abnormal appearance. Note the irregular, hypoechoic interface between the cervix and retrocervical/rectal endometriotic implant. Findings are consistent with posterior cul-de-sac obliteration “frozen pelvis” (AVI 9026 KB). Rights and permissions About this article Cite this article Young, S.W., Saphier, N.B., Dahiya, N. et al. Sonographic evaluation of deep endometriosis: protocol for a US radiology practice. Abdom Radiol 41, 2364–2379 (2016). https://doi.org/10.1007/s00261-016-0886-5 Published: Issue date: DOI: https://doi.org/10.1007/s00261-016-0886-5