Diagnosis of deep infiltrating endometriosis: accuracy of magnetic resonance imaging and transvaginal 3D ultrasonography

Rosario Francesco Grasso, di Giacomo V, Vincenza Di Giacomo, Sedati P, Pietro Sedati, Ornella Sizzi, Sizzi O, Florio G, Giuseppe Florio, Faiella E, Eliodoro Faiella, Alfonso Rossetti, Rossetti A, Riccardo Del Vescovo, Del Vescovo R, Bruno Beomonte Zobel, Zobel BB
Abdominal imaging · 2009 · vol. 35(6) , pp. 716–725 · doi:10.1007/s00261-009-9587-7 · PMID:19924468 · W2032171970
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⚙ AI-generated summary by claude@2026-06+body, 2026-06-12 ⓘ

Magnetic resonance imaging accurately diagnoses deep infiltrating endometriosis, while 3D ultrasonography accurately diagnoses it in specific pelvic locations.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 · read from full text ⓘ

This study compared magnetic resonance imaging (MRI) and transvaginal three-dimensional ultrasonography (3DUS) for preoperative mapping of deep infiltrating endometriosis in 33 women, with imaging of multiple pelvic sites (uterus torus/uterosacral ligaments, vagina, rectovaginal septum, rectosigmoid, bladder, and ovaries) and subsequent surgical and histopathological confirmation. MRI and 3DUS showed high specificity for several sites, but sensitivity varied markedly by location; for example, 3DUS sensitivity/specificity for deep disease were low for rectosigmoid and bladder (e.g., rectosigmoid 33.3% sensitivity, bladder 25% sensitivity) and higher for rectovaginal-septum (76.9%/100%) and USL (50%/94.7%). The paper’s major caveat is the small, single-cohort sample (n=33) evaluating site-by-site performance rather than an overall standardized extension metric. This paper is centrally about endometriosis — specifically, it assesses the diagnostic accuracy of MRI versus transvaginal 3D ultrasound for deep infiltrating endometriosis by anatomical site.

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Abstract

PurposeTo compare two different imaging modalities, magnetic resonance (MR), and three-dimensional sonography (3DUS), in order to evaluate the specific role in preoperative work-up of deep infiltrating endometriosis.Materials and methods33 women with endometriosis underwent 3DUS and MR followed by surgical and histopathological investigations. Investigators described the disease extension in the following sites: torus uterinus and uterosacral ligaments (USL), vagina, rectovaginal-septum, rectosigmoid, bladder, ovaries. Results were compared with surgical and histopathological findings.ResultsOvarian and deep pelvic endometriosis were found by surgery and histology in, respectively, 24 (72.7%) and 22 (66.6%) of the 33 patients. Sensitivity and specificity values of 3DUS for the diagnosis of endometrial cysts were 87.5% and 100%, respectively; those of MRI were 96.8% and 91.1%, respectively. Sensitivity and specificity of 3DUS for the diagnosis of deep infiltrating endometriosis in specific sites were: USL 50% and 94.7%; vagina 84% and 80%; rectovaginal-septum 76.9% and 100%; rectosigmoid 33.3% and 100%; bladder 25% and 100%. Those of MR were: USL 69.2% and 94.3%; vagina 83.3% and 88.8%; rectovaginal-septum 76.4% and 100%; restosigmoid 75% and 100%; bladder 83.3% and 100%.ConclusionsMR accurately diagnoses deep infiltrating endometriosis; 3DUS accurately diagnoses deep infiltrating endometriosis in specific locations.
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Abstract

Purpose To compare two different imaging modalities, magnetic resonance (MR), and three-dimensional sonography (3DUS), in order to evaluate the specific role in preoperative work-up of deep infiltrating endometriosis.

Materials and methods

33 women with endometriosis underwent 3DUS and MR followed by surgical and histopathological investigations. Investigators described the disease extension in the following sites: torus uterinus and uterosacral ligaments (USL), vagina, rectovaginal-septum, rectosigmoid, bladder, ovaries. Results were compared with surgical and histopathological findings.

Results

Ovarian and deep pelvic endometriosis were found by surgery and histology in, respectively, 24 (72.7%) and 22 (66.6%) of the 33 patients. Sensitivity and specificity values of 3DUS for the diagnosis of endometrial cysts were 87.5% and 100%, respectively; those of MRI were 96.8% and 91.1%, respectively. Sensitivity and specificity of 3DUS for the diagnosis of deep infiltrating endometriosis in specific sites were: USL 50% and 94.7%; vagina 84% and 80%; rectovaginal-septum 76.9% and 100%; rectosigmoid 33.3% and 100%; bladder 25% and 100%. Those of MR were: USL 69.2% and 94.3%; vagina 83.3% and 88.8%; rectovaginal-septum 76.4% and 100%; restosigmoid 75% and 100%; bladder 83.3% and 100%.

Conclusions

MR accurately diagnoses deep infiltrating endometriosis; 3DUS accurately diagnoses deep infiltrating endometriosis in specific locations. Similar content being viewed by others

References

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Condition tags

endometriosisdie_deep_infiltrating

MeSH descriptors

Endometriosis Endometriosis Imaging, Three-Dimensional Magnetic Resonance Imaging Ultrasonography Adult Contrast Media Diagnosis, Differential Endometriosis Endometriosis Female Gadolinium DTPA Humans Magnetic Resonance Imaging Middle Aged Prospective Studies Sensitivity and Specificity Ultrasonography Vagina

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