Modern use of radiological diagnostic methods in patients with deep infiltrating endometriosis

Elizaveta M. Tcybuk, Elizaveta V. Shelaeva, Anna A. Tsypurdeeva, Maria I. Yarmolinskaya
In: Journal of obstetrics and women's diseases · 2025 · vol. 74(3) , pp. 103–113 · doi:10.17816/jowd642740 · W4412602689
article OA: closed CC0
Full text JSON View on OpenAlex View at publisher
⚙ AI-generated summary by claude@2026-06, 2026-06-06 ⓘ

This review examines the advantages, disadvantages, and accuracy of modern radiological methods like ultrasound, MRI, and CT for diagnosing deep infiltrating endometriosis and planning surgical interventions.

One-sentence paraphrase of the abstract; not a substitute for reading it. No clinical advice. How this works

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

This 2025 review examines modern radiological diagnostic methods for deep infiltrating endometriosis, surveying the use of ultrasound (including advanced modes), magnetic resonance imaging, and computed tomography, and synthesizing Russian and international evidence on their advantages, disadvantages, and diagnostic accuracy across deep lesion types. It also describes how preoperative imaging can support staging and assessment of disease severity and prevalence using existing classification systems, with the stated benefit of simplifying multidisciplinary planning and surgical volume estimation, including complication prediction at the examination stage. The paper’s main limitation, consistent with a narrative review format, is that it does not present new original diagnostic accuracy data. This paper is centrally about endometriosis — specifically, deep infiltrating endometriosis and the comparative value of imaging modalities for diagnosis, staging, and preoperative assessment.

Read from the paper's body, not the abstract. Not a substitute for reading the paper. No clinical advice. How this works

Abstract

Endometriosis is one of the most heterogeneous diseases in both its clinical manifestations and forms, and its course. Deep infiltrating endometriosis is a severe form of endometriosis, which currently occurs in every fifth patient with this disease. In clinical practice, timely diagnosis is extremely important, which contributes to the early start of treatment of these patients. However, delays in diagnosis can reach many years for a number of reasons. Those range from underestimation of symptoms by women, to difficulties in differential diagnosis with many other diseases that have a similar clinical picture. Among other reasons, there could be the experience and qualifications of specialists involved in the management of patients with suspected endometriosis. This article presents a modern review of radiation methods for diagnosing deep infiltrating endometriosis such as various modes of ultrasound, magnetic resonance imaging, and computed tomography. The article provides current Russian and foreign literature on their advantages and disadvantages, the accuracy of diagnosing various forms of deep infiltrating endometriosis, as well as the possibility of staging and assessing the severity and prevalence of the disease using various visualization methods according to the existing classification systems. The effectiveness of preoperative diagnostics of deep infiltrating endometriosis simplifies the interaction between related specialists that treat these patients. It also allows for competent planning of the proposed surgical volume, predicting possible complications at the preoperative examination stage, and providing for preventive measures.
Full text 16,636 characters · extracted from oa-doi-fallback · click to expand
Modern use of radiological diagnostic methods in patients with deep infiltrating endometriosis - Authors: Tcybuk E.M.1, Shelaeva E.V.1, Tsypurdeeva A.A.1, Yarmolinskaya M.I.1 - Affiliations: - The Research Institute of Obstetrics, Gynecology, and Reproductology named after D.O. Ott - Issue: Vol 74, No 3 (2025) - Pages: 103-113 - Section: Reviews - Submitted: 09.12.2024 - Accepted: 17.04.2025 - Published: 23.07.2025 - URL: https://journals.eco-vector.com/jowd/article/view/642740 - DOI: https://doi.org/10.17816/JOWD642740 - EDN: https://elibrary.ru/MYALOE - ID: 642740 Cite item Abstract Endometriosis is one of the most heterogeneous diseases in both its clinical manifestations and forms, and its course. Deep infiltrating endometriosis is a severe form of endometriosis, which currently occurs in every fifth patient with this disease. In clinical practice, timely diagnosis is extremely important, which contributes to the early start of treatment of these patients. However, delays in diagnosis can reach many years for a number of reasons. Those range from underestimation of symptoms by women, to difficulties in differential diagnosis with many other diseases that have a similar clinical picture. Among other reasons, there could be the experience and qualifications of specialists involved in the management of patients with suspected endometriosis. This article presents a modern review of radiation methods for diagnosing deep infiltrating endometriosis such as various modes of ultrasound, magnetic resonance imaging, and computed tomography. The article provides current Russian and foreign literature on their advantages and disadvantages, the accuracy of diagnosing various forms of deep infiltrating endometriosis, as well as the possibility of staging and assessing the severity and prevalence of the disease using various visualization methods according to the existing classification systems. The effectiveness of preoperative diagnostics of deep infiltrating endometriosis simplifies the interaction between related specialists that treat these patients. It also allows for competent planning of the proposed surgical volume, predicting possible complications at the preoperative examination stage, and providing for preventive measures. Full Text About the authors Elizaveta M. Tcybuk The Research Institute of Obstetrics, Gynecology, and Reproductology named after D.O. Ott Author for correspondence. Email: [email protected] ORCID iD: 0000-0001-5803-1668 SPIN-code: 3466-7910 Russian Federation, Saint Petersburg Elizaveta V. Shelaeva The Research Institute of Obstetrics, Gynecology, and Reproductology named after D.O. Ott Email: [email protected] ORCID iD: 0000-0002-9608-467X SPIN-code: 7440-0555 MD, Cand. Sci. (Medicine) Russian Federation, Saint PetersburgAnna A. Tsypurdeeva The Research Institute of Obstetrics, Gynecology, and Reproductology named after D.O. Ott Email: [email protected] ORCID iD: 0000-0001-7774-2094 SPIN-code: 5208-9707 MD, Cand. Sci. (Medicine) Russian Federation, Saint PetersburgMaria I. Yarmolinskaya The Research Institute of Obstetrics, Gynecology, and Reproductology named after D.O. Ott Email: [email protected] ORCID iD: 0000-0002-6551-4147 SPIN-code: 3686-3605 Professor, Professor of the Russian Academy of Sciences, Honored Scientist of the Russian Federation Russian Federation, Saint PetersburgReferences - Becker CM, Bokor A, Heikinheimo O, et al. ESHRE guideline: endometriosis. Hum Reprod Open. 2022;2022(2):hoac009. doi: 10.1093/hropen/hoac009 - Taylor HS, Kotlyar AM, Flores VA. Endometriosis is a chronic systemic disease: clinical challenges and novel innovations. Lancet. 2021;397(10276):839–852. EDN: ZPYWIM doi: 10.1016/S0140-6736(21)00389-5 - International working group of AAGL, ESGE, ESHRE and WES, Tomassetti C, Johnson NP, Petrozza J, et al. An international terminology for endometriosis, 2021. J Minim Invasive Gynecol. 2021;28(11):1849–1859. EDN: SNDUQU doi: 10.1016/j.jmig.2021.08.032 - Zhang P, Wang G. Progesterone resistance in endometriosis: current evidence and putative mechanisms. Int J Mol Sci. 2023;24(8):6992. EDN: MQGJHB doi: 10.3390/ijms24086992 - Bonavina G, Taylor HS. Endometriosis-associated infertility: From pathophysiology to tailored treatment. Front Endocrinol (Lausanne). 2022;13:1020827. EDN: SQMESK doi: 10.3389/fendo.2022.1020827 - Yarmolinskaya MI, Aylamazyan EK. Genital endometriosis. Various aspects of the problem. Saint Petersburg: Eko-Vektor; 2017. (In Russ). EDN: XYSZVJ - Barra F, Zorzi C, Albanese M, et al. Ultrasonographic characterization of parametrial endometriosis: a prospective study. Fertil Steril. 2024;122(1):150–161. EDN: EGYYZD doi: 10.1016/j.fertnstert.2024.02.031 - Aylamazyan EK, Yarmolinskaya MI, Molotkov AS, et al. Classifications of endometriosis. Journal of obstetrics and women’s diseases. 2017;66(2):77–92. EDN: YNBWDV doi: 10.17816/JOWD66277-92 - Zegers-Hochschild F, Adamson GD, Dyer S, et al. The international glossary on infertility and fertility care, 2017. Fertil Steril. 2017;108(3):393–406. doi: 10.1016/j.fertnstert.2017.06.005 - Davenport S, Smith D, Green DJ. Barriers to a timely diagnosis of endometriosis: a qualitative systematic review. Obstet Gynecol. 2023;142(3):571–583. EDN: PJDXBE doi: 10.1097/AOG.0000000000005255 - Dunselman GA, Vermeulen N, Becker C, European Society of Human Reproduction and Embryology, et al. ESHRE guideline: management of women with endometriosis. Hum Reprod. 2014;29(3):400–412. doi: 10.1093/humrep/det457 - Russian Society of Obstetricians and Gynecologists. Endometriosis. Clinical guidelines. Moscow: Russian Ministry of Health; 2024. - Condous G, Gerges B, Thomassin-Naggara I, et al. Non-invasive imaging techniques for diagnosis of pelvic deep endometriosis and endometriosis classification systems: an international consensus statement. J Minim Invasive Gynecol. 2024;31(7):557–573. EDN: PBPQEW doi: 10.1016/j.jmig.2024.04.006 - Savelli L, Fabbri F, Zannoni L, et al. Preoperative ultrasound diagnosis of deep endometriosis: importance of the examiner’s expertise and lesion size. Australas J Ultrasound Med. 2012;15(2):55–60. doi: 10.1002/j.2205-0140.2012.tb00227.x - Guerriero S, Condous G, van den Bosch T, et al. Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis, including terms, definitions and measurements: a consensus opinion from the International Deep Endometriosis Analysis (IDEA) group. Ultrasound Obstet Gynecol. 2016;48(3):318–332. doi: 10.1002/uog.15955 - Van den Bosch T, Dueholm M, Leone FP, et al. Terms, definitions and measurements to describe sonographic features of myometrium and uterine masses: a consensus opinion from the Morphological Uterus Sonographic Assessment (MUSA) group. Ultrasound Obstet Gynecol. 2015;46(3):284–298. doi: 10.1002/uog.14806 - Timmerman D, Valentin L, Bourne TH, International Ovarian Tumor Analysis (IOTA) Group, et al. Terms, definitions and measurements to describe the sonographic features of adnexal tumors: a consensus opinion from the International Ovarian Tumor Analysis (IOTA) Group. Ultrasound Obstet Gynecol. 2000;16(5):500–505. doi: 10.1046/j.1469-0705.2000.00287.x - Carmignani L, Vercellini P, Spinelli M, et al. Pelvic endometriosis and hydroureteronephrosis. Fertil Steril. 2010;93(6):1741–1744. doi: 10.1016/j.fertnstert.2008.12.038 - Leonardi M, Uzuner C, Mestdagh W, et al. Diagnostic accuracy of transvaginal ultrasound for detection of endometriosis using International Deep Endometriosis Analysis (IDEA) approach: prospective international pilot study. Ultrasound Obstet Gynecol. 2022;60(3):404–413. EDN: ANHZSW doi: 10.1002/uog.24936 - Barra F, Ferrero S, Zorzi C, et al. “From the tip to the deep of the iceberg”: Parametrial involvement in endometriosis. Best Pract Res Clin Obstet Gynaecol. 2024;94:102493. EDN: FRHXVF doi: 10.1016/j.bpobgyn.2024.102493 - Guerriero S, Martinez L, Gomez I, et al. Diagnostic accuracy of transvaginal sonography for detecting parametrial involvement in women with deep endometriosis: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2021;58(5):669–676. EDN: CBYJMB doi: 10.1002/uog.23754 - Guerriero S, Condous G, Rolla M, et al. Addendum to consensus opinion from International Deep Endometriosis Analysis (IDEA) group: sonographic evaluation of the parametrium. Ultrasound Obstet Gynecol. 2024;64(2):275–280. EDN: VPOIOT doi: 10.1002/uog.27558 - Szabó G, Bokor A, Fancsovits V, et al. Clinical and ultrasound characteristics of deep endometriosis affecting sacral plexus. Ultrasound Obstet Gynecol. 2024;64(1):104–111. EDN: LCFPEX doi: 10.1002/uog.27602 - Avery JC, Deslandes A, Freger SM, et al. Noninvasive diagnostic imaging for endometriosis part 1: a systematic review of recent developments in ultrasound, combination imaging, and artificial intelligence. Fertil Steril. 2024;121(2):164–188. EDN: TDDYEX doi: 10.1016/j.fertnstert.2023.12.008 - Xholli A, Londero AP, Cavalli E, et al. The benefit of transvaginal elastography in detecting deep endometriosis: a feasibility study. Ultraschall Med. 2024;45(1):69–76. EDN: HZRZHS doi: 10.1055/a-2028-8214 - Scioscia M, Laganà AS, Caringella G, et al. Transvaginal strain elastosonography in the differential diagnosis of rectal endometriosis: some potentials and limits. Diagnostics (Basel). 2021;11(1):99. EDN: HRZTLD doi: 10.3390/diagnostics11010099 - Viganò P, Ottolina J, Bartiromo L, et al. Cellular components contributing to fibrosis in endometriosis: a literature review. J Minim Invasive Gynecol. 2020;27(2):287–295. EDN: HYBCAZ doi: 10.1016/j.jmig.2019.11.011 - Szabó G, Madár I, Bokor A, et al. OC20.01: Preoperative mapping of deep infiltrating endometriosis in the posterior compartment using transvaginal strain elastography and IDEA classification. Ultrasound Obstet Gynecol. 2019;54(S1):50. doi: 10.1002/uog.20557 - Szabó G, Madár I, Bokor A, et al. Transvaginal strain elastosonography may help in the differential diagnosis of endometriosis? Diagnostics (Basel). 2021;11(1):100. EDN: YFAMVT doi: 10.3390/diagnostics11010100 - Healy DL, Rogers PA, Hii L, et al. Angiogenesis: a new theory for endometriosis. Hum Reprod Update. 1998;4(5):736–740. EDN: IPKASN doi: 10.1093/humupd/4.5.736 - Powell SG, Sharma P, Masterson S, et al. Vascularisation in deep endometriosis: a systematic review with narrative outcomes. Cells. 2023;12(9):1318. EDN: IGOCSA doi: 10.3390/cells12091318 - Raimondo D, Mastronardi M, Mabrouk M, et al. Rectosigmoid endometriosis vascular patterns at intraoperative indocyanine green angiography and their correlation with clinicopathological data. Surg Innov. 2020;27(5):474–480. EDN: WDDMJG doi: 10.1177/1553350620930147 - Ramón LA, Braza-Boïls A, Gilabert-Estellés J, et al. microRNAs expression in endometriosis and their relation to angiogenic factors. Hum Reprod. 2011;26(5):1082–1090. doi: 10.1093/humrep/der025 - Grasso RF, Di Giacomo V, Sedati P, et al. Diagnosis of deep infiltrating endometriosis: accuracy of magnetic resonance imaging and transvaginal 3D ultrasonography. Abdom Imaging. 2010;35(6):716–725. EDN: FRXFUK doi: 10.1007/s00261-009-9587-7 - Guerriero S, Alcázar JL, Pascual MA, et al. Deep infiltrating endometriosis: comparison between 2-dimensional ultrasonography (US), 3-dimensional US, and magnetic resonance imaging. J Ultrasound Med. 2018;37(6):1511–1521. doi: 10.1002/jum.14496 - Guerriero S, Saba L, Ajossa S, et al. Three-dimensional ultrasonography in the diagnosis of deep endometriosis. Hum Reprod. 2014;29(6):1189–1198. doi: 10.1093/humrep/deu054 - Siegelman ES, Oliver ER. MR imaging of endometriosis: ten imaging pearls. Radiographics. 2012;32(6):1675–1691. doi: 10.1148/rg.326125518 - Shankar L, Montanera W. Computed tomography versus magnetic resonance imaging and three-dimensional applications. Med Clin North Am. 1991;75(6):1355–1366. doi: 10.1016/s0025-7125(16)30392-3 - Hoyos LR, Johnson S, Puscheck E. Endometriosis and imaging. Clin Obstet Gynecol. 2017;60(3):503–516. doi: 10.1097/GRF.0000000000000305 - Ruaux E, Nougaret S, Gavrel M, et al. Endometriosis MR mimickers: T1-hyperintense lesions. Insights Imaging. 2024;15(1):19. EDN: HEHILN doi: 10.1186/s13244-023-01587-3 - Guerriero S, Saba L, Pascual MA, et al. Transvaginal ultrasound vs magnetic resonance imaging for diagnosing deep infiltrating endometriosis: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2018;51(5):586–595. doi: 10.1002/uog.18961 - Moura APC, Ribeiro HSAA, Bernardo WM, et al. Accuracy of transvaginal sonography versus magnetic resonance imaging in the diagnosis of rectosigmoid endometriosis: Systematic review and meta-analysis. PLoS One. 2019;14(4):e0214842. doi: 10.1371/journal.pone.0214842 - Nisenblat V, Bossuyt PM, Farquhar C, et al. Imaging modalities for the non-invasive diagnosis of endometriosis. Cochrane Database Syst Rev. 2016;2(2):CD009591. doi: 10.1002/14651858.CD009591.pub2c - Medeiros LR, Rosa MI, Silva BR, et al. Accuracy of magnetic resonance in deeply infiltrating endometriosis: a systematic review and meta-analysis. Arch Gynecol Obstet. 2015;291(3):611–621. EDN: UQAKFN doi: 10.1007/s00404-014-3470-7 - Nisenblat V, Bossuyt PM, Farquhar C, et al. Imaging modalities for the non-invasive diagnosis of endometriosis. Cochrane Database Syst Rev. 2016;2(2):CD009591. doi: 10.1002/14651858.CD009591.pub2 - Woo S, Suh CH, Kim H. Diagnostic performance of computed tomography for bowel endometriosis: a systematic review and meta-analysis. Eur J Radiol. 2019;119:108638. doi: 10.1016/j.ejrad.2019.08.007 - Biscaldi E, Ferrero S, Remorgida V, et al. Bowel endometriosis: CT-enteroclysis. Abdom Imaging. 2007;32(4):441–450. EDN: KFJUIE doi: 10.1007/s00261-006-9152-6 - Hendee WR, Edwards FM. ALARA and an integrated approach to radiation protection. Semin Nucl Med. 1986;16(2):142–150. doi: 10.1016/s0001-2998(86)80027-7 - Gerges B, Li W, Leonardi M, Mol BW, et al. Optimal imaging modality for detection of rectosigmoid deep endometriosis: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2021;58(2):190–200. EDN: YANUJC doi: 10.1002/uog.23148 - Revised American Fertility Society classification of endometriosis: 1985. Fertil Steril. 1985;43(3):351–352. doi: 10.1016/s0015-0282(16)48430-x - Revised American Society for Reproductive Medicine classification of endometriosis: 1996. Fertil Steril. 1997;67(5):817–821. doi: 10.1016/s0015-0282(97)81391-x - Vercellini P, Fedele L, Aimi G, et al. Reproductive performance, pain recurrence and disease relapse after conservative surgical treatment for endometriosis: the predictive value of the current classification system. Hum Reprod. 2006;21(10):2679–2685. EDN: IPIJYP doi: 10.1093/humrep/del230 - Leonardi M, Espada M, Choi S, et al. Transvaginal ultrasound can accurately predict the american society of reproductive medicine stage of endometriosis assigned at laparoscopy. J Minim Invasive Gynecol. 2020;27(7):1581–1587.e1. EDN: IYWOTS doi: 10.1016/j.jmig.2020.02.014 - Holland TK, Yazbek J, Cutner A, et al. Value of transvaginal ultrasound in assessing severity of pelvic endometriosis. Ultrasound Obstet Gynecol. 2010;36(2):241–248. doi: 10.1002/uog.7689 - Tuttlies F, Keckstein J, Ulrich U, et al. ENZIAN-score, a classification of deep infiltrating endometriosis. Zentralbl Gynakol. 2005;127(5):275–281. doi: 10.1055/s-2005-836904 - Keckstein J, Saridogan E, Ulrich UA, et al. The #Enzian classification: a comprehensive non-invasive and surgical description system for endometriosis. Acta Obstet Gynecol Scand. 2021;100(7):1165–1175. EDN: YPAGRG doi: 10.1111/aogs.14099 - Montanari E, Bokor A, Szabó G, et al. Accuracy of sonography for non-invasive detection of ovarian and deep endometriosis using #Enzian classification: prospective multicenter diagnostic accuracy study. Ultrasound Obstet Gynecol. 2022;59(3):385–391. EDN: DGWFBB doi: 10.1002/uog.24833 - Enzelsberger SH, Oppelt P, Nirgianakis K, et al. Preoperative application of the Enzian classification for endometriosis (The cEnzian Study): a prospective international multicenter study. BJOG. 2022;129(12):2052–2061. EDN: DIKLHW doi: 10.1111/1471-0528.17235 - Fendal Tunca A, Iliman DE, Akdogan Gemici A, et al. Predictive value of preoperative MRI using the #ENZIAN classification score in patients with deep infiltrating endometriosis. Arch Gynecol Obstet. 2023;307(1):215–220. EDN: TFWLYU doi: 10.1007/s00404-022-06451-1 - Maciel C, Ferreira H, Djokovic D, et al. MRI of endometriosis in correlation with the #Enzian classification: applicability and structured report. Insights Imaging. 2023;14(1):120. EDN: ZFEFDN doi: 10.1186/s13244-023-01466-x

Text is read by the "Ask this paper" AI Q&A widget below. Extraction quality varies by source — PMC NXML preserves structure cleanly, OA-HTML may include some navigation residue, and OA-PDF can have broken hyphenation. The publisher copy (via DOI) is the canonical version.

My notes (saved in your browser only)

⚙ Ask this paper AI returns verbatim quotes from the full text · source: oa-doi-fallback ⓘ

Answers must be backed by verbatim quotes from this paper's full text. Hallucinated quotes are dropped automatically; if no verbatim passage answers the question, we say so. How this works

Condition tags

endometriosisdie_deep_infiltrating

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.

References (57)

Source provenance

openalex
last seen: 2026-06-10T17:14:06.276822+00:00
License: CC0 · commercial use OK