OC23: Magnetic resonance imaging and transvaginal tenderness‐guided ultrasonography in diagnosis of the location of deep infiltrating endometriosis

The aim of our study was to compare the diagnostic accuracy of transvaginal tenderness-guided ultrasonography and pelvic magnetic resonance imaging (MRI) in identification of the location of deep endometriosis implants. The study was performed in 43 patients suspected who have deep pelvic endometriosis, underwent both MRI and transvaginal tenderness-guided ultrasonography preoperatively. The modified ultrasound approach consists of the use of a larger amount of ultrasound gel in the glove to create a stand-off with better visualization of the vaginal walls and posterior fornix. In addition, the operator evaluated with particular attention the painful sites, as indicated by patients and evoked by a gentle pressure in the specific locations examined: vaginal walls, rectal walls, uterosacral ligaments and anterior compartment (anterior pouch and/or bladder). MRI was carried out using turbo spin-echo (TSE) sequences in T1, T2 and weighted fat-suppressed T1. Deep pelvic endometriosis was present 84% of patients. The sensitivity, specificity, positive and negative predictive values of MRI and ultrasound, respectively, were 65% and 90%, 62% and 87%, 62% and 86%, and 61% and 98% for vaginal location; 33% and 57%, 77% and 86%, 58% and 80%, and 55% and 68% for rectal involvement; 17% and 50%, 87%, and 97%, 33% and 86% and 73% and 83% for uterosacral involvement; and 25% and 37%, 97% and 100%, 67%, and 100% and 85% and 87% for the anterior location. Our modified ultrasonographic approach shows similar accuracy to MRI for diagnosis of the location of deep pelvic endometriosis.