Diagnostic performance of MRI and transvaginal ultrasound for urinary tract endometriosis: a systematic review and meta-analysis

Objective To compare the diagnostic accuracy of transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI) for detecting urinary tract endometriosis (UTE), including ureteral and bladder involvement.

A systematic review and meta-analysis were conducted according to PRISMA 2020 guidelines. PubMed, Embase, and Scopus were searched from inception to December 2025 for diagnostic accuracy studies evaluating TVUS and/or MRI for UTE. Surgical findings, with or without histopathological confirmation, were used as the reference standard. Studies reporting sufficient data to construct 2 × 2 contingency tables were included. Pooled sensitivity and specificity with 95% confidence intervals (CI) were calculated using a bivariate random-effects model, with separate analyses for ureteral and bladder endometriosis.

Thirty-six studies met the inclusion criteria. For ureteral endometriosis, TVUS demonstrated a pooled sensitivity of 0.89 (95% CI 0.65–0.97) and specificity of 1.00 (95% CI 0.97–1.00), while MRI showed a pooled sensitivity of 0.96 (95% CI 0.50–1.00) and specificity of 1.00 (95% CI 0.96–1.00). For bladder endometriosis, TVUS yielded a pooled sensitivity of 0.70 (95% CI 0.55–0.81) and specificity of 1.00 (95% CI 0.99–1.00), whereas MRI demonstrated a pooled sensitivity of 0.77 (95% CI 0.58–0.89) and specificity of 0.99 (95% CI 0.98–1.00). Substantial heterogeneity was observed, particularly for sensitivity estimates.

TVUS and MRI show excellent specificity for diagnosing urinary tract endometriosis. MRI provides slightly higher sensitivity for ureteral disease, while both modalities demonstrate moderate sensitivity for bladder involvement. A complementary, site-specific imaging approach is, therefore, supported, with cautious interpretation of negative findings. Funding Open access funding provided by Università di Foggia within the CRUI-CARE Agreement. No funds, grants, or other support was received. Author information Authors and Affiliations Corresponding author Ethics declarations Conflict of interest The authors have no relevant financial or non-financial interests to disclose. Ethical approval Not applicable. Ethical approval was not required for this study as it is a systematic review and meta-analysis of previously published data Consent to participate Not applicable Consent for publication Not applicable Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Supplementary Information Below is the link to the electronic supplementary material. Rights and permissions Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. About this article Cite this article Pitsillidi, A., Vona, L., Kyriakoulis, K. et al. Diagnostic performance of MRI and transvaginal ultrasound for urinary tract endometriosis: a systematic review and meta-analysis. Arch Gynecol Obstet (2026). https://doi.org/10.1007/s00404-026-08553-6 Received: Accepted: Published: DOI: https://doi.org/10.1007/s00404-026-08553-6