The “Speckle Sign” in the Diagnosis of Posterior Compartment Endometriosis

Patricia Balcacer, Adrian Jaramillo-Cardoso, Adrian Jaramillo‐Cardoso, Jaramillo-Cardoso A, Sonia Gupta, Gupta S, Koenraad Mortele, Mortele K, Koenraad J. Mortelé, Samuel C. Johnson, Johnson SC
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine · 2021 · vol. 40(10) , pp. 2181–2188 · doi:10.1002/jum.15611 · PMID:33417291 · W3120764345
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This study found the "speckle sign," characterized by irregular obliteration and hyperechoic echoes of the posterior cul-de-sac, to be a useful diagnostic marker for posterior compartment endometriosis.

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Abstract

OBJECTIVE: To determine usefulness of the "speckle sign" in the diagnosis of deep invasive endometriosis. MATERIALS AND METHODS: This HIPAA-compliant, institutional review board-approved retrospective study with informed consent waived included 25 women (mean age 20-69 years) with histopathologically confirmed posterior cul-de-sac endometriosis between 2013 and 2018. Transvaginal ultrasound exams of these patients were reviewed by 2 expert radiologists searching for the "speckle sign," defined as irregular obliteration of the posterior cul-de-sac and bright (hyperechoic) internal echoes. The frequency of additional findings such as "kissing ovaries," endometriomas in the adnexa, bowel tethering in the posterior pelvic compartment, retroflexed uterus, adenomyosis, and pelvic free fluid were also analyzed. Data regarding clinical features, histopathologic findings and management were collected through a review of the medical record. RESULTS: Reader one identified posterior compartment endometriosis in 20/25 patients, and reader two in 22/25 patients, with 96% agreement. Adnexal endometriomas were found in 21/25 patients for both readers (k = 0.70) and were bilateral in 23% of patients. The ovaries were adherent to each other in the midline ("kissing ovaries") in 50% of patients; the bowel was tethered anteriorly in 20%; the presence of adenomyosis was seen in about 27%, and a retroflexed uterus was seen in 24% of patients. CONCLUSIONS: The speckle sign could be helpful in making the diagnosis of posterior compartment endometriosis, and the sign is often found in conjunction with other imaging features of endometriosis.

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Condition tags

endometriosisadenomyosis

MeSH descriptors

Adenomyosis Endometriosis Endometriosis Adult Aged Douglas' Pouch Female Humans Middle Aged Retrospective Studies Ultrasonography Young Adult

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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