Indirect and atypical imaging signals of endometriosis: A wide range of manifestations

Vigueras Smith A, Andres Vigueras Smith, A. Vigueras Smith, Ramiro Cabrera, Cabrera R, R. Cabrera, Trippia C, Cesar Rodrigo Trippia, C Trippia, Monica T. Zomer, M Tessman Zomer, Tessman Zomer M, William Kondo, W Kondo, Kondo W, Hélder Ferreira, Ferreira H, H. Ferreira, L Carttaxo Da Silva, Carttaxo Da Silva L, Rok Šumak, R Sumak, Sumak R
Facts, views & vision in ObGyn · 2021 · vol. 13(4) , pp. 339–356 · doi:10.52054/fvvo.13.4.048 · PMID:35026096 · PMC9148709 · W4205420583
article OA: gold CC0 ⤵ 3 in-corpus citations
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-10 ⓘ

This review analyzes current transvaginal ultrasound and MRI findings, including subtle signs like reduced sliding and bowel deviation, to improve endometriosis diagnosis and surgical planning.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-10 · read from full text ⓘ

This paper is a comprehensive narrative review that summarizes and analyzes existing literature on indirect and atypical imaging signs of endometriosis assessed by transvaginal ultrasound (US) and magnetic resonance imaging (MRI). Using PubMed and Google Scholar, the authors selected studies for the diagnosis of indirect signs, reporting that transvaginal US can achieve sensitivity of about 79–94% and specificity around 94% by enabling dynamic assessment of sliding between compartments to detect adhesions or fibrosis, while MRI can reach sensitivity around 94% and specificity around 77% by visualizing uterine and bowel loop deviation, peritoneal inclusion cysts, and features such as ovarian cyst categorization and septum obliteration with small bowel implants. The authors emphasize a limitation typical of reviews—that it reflects the included studies and their reported performance rather than introducing new direct primary data. This paper is centrally about endometriosis — it specifically focuses on summarizing indirect and atypical US/MRI imaging manifestations used for diagnosis and surgical planning.

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Abstract

BACKGROUND: Whilst some imaging signs of endometriosis are common and widely accepted as 'typical', a range of 'subtle' signs could be present in imaging studies, presenting an opportunity to the radiologist and the surgeon to aid the diagnosis and facilitate preoperative surgical planning. OBJECTIVE: To summarise and analyse the current information related to indirect and atypical signs of endometriosis by ultrasound (US) and magnetic resonance imaging (MRI). METHODS: Through the use of PubMed and Google scholar, we conducted a comprehensive review of available articles related to the diagnosis of indirect signs in transvaginal US and MRI. All abstracts were assessed and the studies were finally selected by two authors. RESULTS: Transvaginal US is a real time dynamic exploration, that can reach a sensitivity of 79-94% and specificity of 94%. It allows evaluation of normal sliding between structures in different compartments, searching for adhesions or fibrosis. MRI is an excellent tool that can reach a sensitivity of 94% and specificity of 77% and allows visualisation of the uterus, bowel loop deviation and peritoneal inclusion cysts. It also allows the categorisation and classification of ovarian cysts, rectovaginal and vesicovaginal septum obliteration, and small bowel endometriotic implants. CONCLUSION: The use of an adequate mapping protocol with systematic evaluation and the reporting of direct and indirect signs of endometriosis is crucial for detailed and safe surgical planning.
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Abstract

Background Whilst some imaging signs of endometriosis are common and widely accepted as ‘typical’, a range of ‘subtle’ signs could be present in imaging studies, presenting an opportunity to the radiologist and the surgeon to aid the diagnosis and facilitate preoperative surgical planning.

Objective

To summarise and analyse the current information related to indirect and atypical signs of endometriosis by ultrasound (US) and magnetic resonance imaging (MRI).

Methods

Through the use of PubMed and Google scholar, we conducted a comprehensive review of available articles related to the diagnosis of indirect signs in transvaginal US and MRI. All abstracts were assessed and the studies were finally selected by two authors.

Results

Transvaginal US is a real time dynamic exploration, that can reach a sensitivity of 79-94% and specificity of 94%. It allows evaluation of normal sliding between structures in different compartments, searching for adhesions or fibrosis.MRI is an excellent tool that can reach a sensitivity of 94% and specificity of 77% and allows visualisation of the uterus, bowel loop deviation and peritoneal inclusion cysts. It also allows the categorisation and classification of ovarian cysts, rectovaginal and vesicovaginal septum obliteration, and small bowel endometriotic implants.

Conclusion

The use of an adequate mapping protocol with systematic evaluation and the reporting of direct and indirect signs of endometriosis is crucial for detailed and safe surgical planning.

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Condition tags

endometriosis

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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