Direct And Indirect Imaging Findings In The Diagnosis Of Ovarian Endometriosis

Endocrine disorders, Cysts, Technical aspects, Surgery, Diagnostic procedure, Ultrasound, MR, Genital / Reproductive system female Authors: B. C. A. Teixeira, A. C. Teixeira, G. C. A. Teixeira, M. Zapparoli; Curitiba/BR DOI: 10.1594/ecr2013/C-1810 Learning objectives Ovarian endometriosis is the most common form of endometriosis and an important cause of infertility and pelvic pain in women at reproductive age. Transvaginal ultrasonography (TVUS) is often the first examination ordered after clinical suspicion of endometriosis and plays an important role in its correct diagnosis. We propose to attend these objectives: To describe TVUS examination technique and imaging findings of ovarian endometriosis based on a series of 50 consecutive patients with laparoscopic and/or histopathological proved diagnosis. To ilustrate the direct and indirect imaging findings...

Endometriosis is defined by the presence of functional endometrial glands and stromal elements outside the uterine cavity, leading to chronic inflammatory changes and adhesions that impact the reproductive cycle. Ovarian endometriosis is the most common form of endometriosis and an important cause of infertility and pelvic pain in women at reproductive age. TVUS is often the first examination ordered after clinical suspicion and plays an important role in its correct diagnosis. To date, the gold standard of diagnosis is direct visualization of lesions with histological... Imaging findings OR Procedure details TRANSVAGINAL ULTRASONOGRAPHY TVUS with endocavitary transducer of 9-5 MHz was generally employed and patients assumed standard gynecologic positioning to enable required maneuvers. TVUS protocol called for mapping of the entire pelvis, evaluating uterus, ovaries, adnexa, retrocervical region, and posterior fornix. The most frequent imaging finding was ovarian endometriomas (85%) with sizes ranging from 10 to 92 mm (mean size 26 mm). Indirect findings such as ovarian adhesions (59%), periadnexal fluid collections (29%) and hyperechoic foci of the cyst wall (15%) were also present and relevant...

Beyond the classic endometriotic cysts other imaging findings can suggest the diagnosis of ovarian endometriosis. In this study, indirect findings such as ovarian adhesions, periadnexal fluid collections and hyperechoic foci of the cyst wall were associated with the disease and helpfull in the diagnosis of early stage endometriosis mainly when in combination with small endometriomas.

Patel MD, Feldstein VA, Chen DC, Lipson SD, Filly RA. Endometriomas: diagnostic performance of US. Radiology 1999 Mar;210(3):739–45. Van Holsbeke C, Van Calster B, Guerriero S, Savelli L, Paladini D, Lissoni AA, et al. Endometriomas: their ultrasound characteristics. Ultrasound Obstet Gynecol 2010 Jun;35(6):730–40. Eskenazi B, Warner M, Bonsignore L, Olive D, Samuels S, Vercellini P. Validation study of nonsurgical diagnosis of endometriosis. Fertil Steril. 2001 Nov; 76(5):929–35. Brown DL, Frates MC, Muto MG, Welch WR. Small echogenic foci in the ovaries: correlation with histologic findings.... Personal Information Department of Radiology, Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Brazil. DAPI (Advanced Diagnostic Imaging), Curitiba, Paraná, Brazil. Bernardo C. A. Teixeira. Contact: [email protected]