Step-by-step endometriosis for radiologists: where to look in ultrasonography

Genital / Reproductive system female, Ultrasound, Education, Pelvic floor dysfunction Authors: B. J. B. D. Lacerda, Y. Lacerda Costa, D. A. D. P. Gonçalves Filho, P. A. Prado Mota, M. L. Ferreira Morais, C. D. Jordao, W. Lôres Filho, F. Andrade de Paula DOI: 10.26044/ecr2025/C-22127 Learning objectives This study aims to review the most common locations, normal patterns, anatomy, and key findings in ultrasound for detecting deep endometriosis. The goal is to guide radiologists on where to look during examinations, ensuring greater accuracy in detecting the disease.

Endometriosis affects approximately 5% to 10% of women of reproductive age [2] and is a chronic, oestrogen-dependent inflammatory gynaecological disease. It is characterised by the growth of tissue similar to the endometrium outside the uterus, potentially affecting organs such as the ovaries, intestines, bladder, and diaphragm. The main symptoms include: chronic pelvic pain, infertility, pain during sexual intercourse, cyclical pain in various locations, associated urinary and bowel symptoms [1,2,5,6,7]. The diagnosis of endometriosis is often delayed, with an estimated interval of over 7 years between... Findings and procedure details Ultrasound assessment for detecting deep endometriosis should follow a systematic and standardised approach, ensuring that all relevant areas are evaluated. Below is a detailed step-by-step guide: Uterine serosa and retrocervical space assessment

detect deep endometriosis foci near the uterus.How to perform: assess the posterior uterine serosa, paying attention to the space between the cervix and rectum. Look for hypoechoic nodules or fibrotic thickening with irregular borders. The presence of hypovascularisation or adhesions may suggest active implants. [Figures: 1, 2, and 5]. Relative positioning of...

Deep endometriosis may be underdiagnosed if radiologists do not perform a systematic and detailed assessment during transvaginal ultrasound. Standardising the examination may help prevent diagnostic errors and facilitate early detection of the disease. Transvaginal ultrasound is the first examination requested by gynaecologists when clinical suspicion of endometriosis arises. It is considered a second-line approach for preoperative mapping, particularly in detecting endometriomas and intestinal involvement. It can be enhanced with advanced techniques, increasing sensitivity without compromising the total examination time. A good ultrasound technique, combined with... Personal information and conflict of interest B. J. B. D. Lacerda: Nothing to disclose Y. Lacerda Costa: Nothing to disclose D. A. D. P. Gonçalves Filho: Nothing to disclose P. A. Prado Mota: Nothing to disclose M. L. Ferreira Morais: Nothing to disclose C. D. Jordao: Nothing to disclose W. Lôres Filho: Nothing to disclose F. Andrade de Paula: Nothing to disclose

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