Ultrasound image of ovarian endometrioma as an indicator of external genital endometriosis

Е. А. Борисова, M. N. Bulanov, Т. А. Макаренко
In: Ultrasound & Functional Diagnostics · 2024 · pp. 37–49 · doi:10.24835/1607-0771-2023-3-37-49 · W4391922016
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⚙ AI-generated summary by claude@2026-06, 2026-06-06 ⓘ

Ultrasound identification of ovarian endometriomas in 95 patients reliably indicated the presence of deep endometriosis, with the "kissing ovaries" sign showing 100% specificity for uterosacral ligament involvement.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-09 ⓘ

This retrospective study evaluated the diagnostic value of ultrasound in 95 patients with ovarian endometriomas identified on ultrasound (January 2019–October 2023), with all cases undergoing surgical treatment and histologic verification. The authors found that endometriomas were visualized together with one or more additional foci of deep endometriosis in most cases, while endometriomas that appeared isolated on ultrasound were still accompanied intraoperatively by superficial peritoneal endometriosis and adhesions. They report that endometriomas co-occur with deep endometriosis in 96.8% of cases and that the “kissing ovaries” sign on bilateral endometriomas showed 100% specificity and 100% positive predictive value for involvement of the sacrouterine ligaments, noting the need to include an expanded pelvic ultrasound protocol in suspected endometriosis workups as a limitation of current algorithms. This paper is centrally about endometriosis — it assesses ultrasound features of ovarian endometrioma (including the “kissing ovaries” sign) as indicators of external and deep genital endometriosis.

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Abstract

Timely preoperative diagnosis of endometrioic cyst (endometrioma), as well as deep endometriosis remains relevant. The aim of the study was to assess the diagnostic value of ultrasound in patients with endometriomas and assess the combination of them with other foci of external genital endometriosis. The study based on retrospective analysis of a date of 95 patients with ultrasound signs of ovarian endometriomas, who underwent examination in MedicoProfi LLC – Borisov Medical and Diagnostic Clinic (Krasnoyarsk) during the period from January 2019 to October 2023. All of patients underwent surgery , followed by morphological evaluation. In the vast majority of cases, it was possible to detect a combination of endometriomas with one or more foci of deep endometriosis. Superficial peritoneal endometriosis and adhesions were found on surgery in all cases when endometriomas appeared isolated on ultrasound. The results of the study showed: endometriomas combined with deep endometriosis in 96.8% of cases. Thus, ultrasound detection of endometrioma is a very reliable sign of deep endometriosis presence. The “kissing ovaries” symptom in bilateral endometriomas can be considered as an absolutely reliable sign of the uterosacral ligaments endometriosis with specificity of 100% and positive predictive value of 100%. The presence of the “kissing ovaries” sign should be depicted in the conclusion of the ultrasound protocol, since it highly suggestive to obliteration of the pouch of Douglas and involvement of adjacent organs (fallopian tubes, intestines, ureters, etc.) in the endometrioid infiltrates, which is extremely important for the surgery planning, as well as in patients with infertility. There is an obvious need to introduce the extended pelvic ultrasound protocol to the diagnostic algorithm for patients with suspected endometriosis, which will more accurately describe the disease extension.

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endometriosisendometriomainfertility

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