Sonographic Assessment of Pelvic Endometriosis

Tom Holland
In: Gynaecological Ultrasound Scanning · 2020 · pp. 121–126 · doi:10.1017/9781108149877.009 · W3007025883
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⚙ AI-generated summary by claude@2026-06, 2026-06-13 ⓘ

This study assessed the utility of transvaginal ultrasound for mapping pelvic endometriosis, demonstrating its potential to replace MRI for pre-operative planning.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-13 · read from full text ⓘ

This chapter describes how pelvic endometriosis is evaluated with ultrasound, emphasizing that disease mapping across multiple pelvic sites (including ovaries, peritoneum, pouch of Douglas, rectum/rectosigmoid/rectovaginal septum, uterosacral ligaments, vagina, and urinary bladder) is important for pre-operative planning and coordination with other specialties. It states that while MRI has been a main pre-operative imaging modality, trained and experienced transvaginal ultrasound can perform a similar role, including helping triage to the correct surgical centre and informing surgical risk planning. A key caveat is that the comparable performance of ultrasound is explicitly tied to correct training and experience, implying variability with operator expertise. This paper is centrally about endometriosis — it is a chapter on sonographic assessment and mapping of deeply infiltrating pelvic endometriosis.

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Abstract

Endometriosis is a common gynaecological problem, affecting approximately 5 per cent of women . The diagnosis can take many years and the condition can cause debilitating pain and infertility. The disease can be found in many sites throughout the pelvis, in particular the ovaries, pelvic peritoneum, pouch of Douglas (POD), rectum, rectosigmoid, rectovaginal septum (RVS), uterosacral ligaments (USLs), vagina and urinary bladder. Mapping of deeply infiltrating disease is essential to enable the correct counselling regarding treatment modalities (medical or surgical) and risks of surgery, triaging to the correct surgical centre, informing the surgeon in order to correctly plan surgery and enabling other specialities, such as colorectal or urology support, to be organized in advance. Magnetic resonance imaging (MRI) has been used as the main pre-operative imaging modality, but with the correct training and experience transvaginal ultrasound can perform the same role .
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- Gynaecological Ultrasound Scanning - Gynaecological Ultrasound Scanning - Copyright page - Contents - Contributors - Chapter 1 Get to Know Your Machine and Scanning Environment - Chapter 2 Baseline Sonographic Assessment of the Female Pelvis - Chapter 3 Difficult Gynaecological Ultrasound Examination - Chapter 4 Sonographic Assessment of Uterine Fibroids and Adenomyosis - Chapter 5 Sonographic Assessment of Congenital Uterine Anomalies - Chapter 6 Sonographic Assessment of Endometrial Pathology - Chapter 7 Sonographic Assessment of Polycystic Ovaries - Chapter 8 Sonographic Assessment of Ovarian Cysts and Masses - Chapter 9 Sonographic Assessment of Pelvic Endometriosis - Chapter 10 Sonographic Assessment of Fallopian Tubes and Tubal Pathologies - Chapter 11 Role of Ultrasound in Assisted Reproductive Treatment - Chapter 12 Operative Ultrasound in Gynaecology - Chapter 13 Sonographic Assessment of Complications Related to Assisted Reproductive Techniques - Chapter 14 Sonographic Assessment of Early Pregnancy - Chapter 15 Tips and Tricks when Using Ultrasound in a Contraception Clinic - Chapter 16 Doppler Ultrasound in Gynaecology - Index - References Published online by Cambridge University Press: 28 February 2020 Book contents - Gynaecological Ultrasound Scanning - Gynaecological Ultrasound Scanning - Copyright page - Contents - Contributors - Chapter 1 Get to Know Your Machine and Scanning Environment - Chapter 2 Baseline Sonographic Assessment of the Female Pelvis - Chapter 3 Difficult Gynaecological Ultrasound Examination - Chapter 4 Sonographic Assessment of Uterine Fibroids and Adenomyosis - Chapter 5 Sonographic Assessment of Congenital Uterine Anomalies - Chapter 6 Sonographic Assessment of Endometrial Pathology - Chapter 7 Sonographic Assessment of Polycystic Ovaries - Chapter 8 Sonographic Assessment of Ovarian Cysts and Masses - Chapter 9 Sonographic Assessment of Pelvic Endometriosis - Chapter 10 Sonographic Assessment of Fallopian Tubes and Tubal Pathologies - Chapter 11 Role of Ultrasound in Assisted Reproductive Treatment - Chapter 12 Operative Ultrasound in Gynaecology - Chapter 13 Sonographic Assessment of Complications Related to Assisted Reproductive Techniques - Chapter 14 Sonographic Assessment of Early Pregnancy - Chapter 15 Tips and Tricks when Using Ultrasound in a Contraception Clinic - Chapter 16 Doppler Ultrasound in Gynaecology - Index - References Endometriosis is a common gynaecological problem, affecting approximately 5 per cent of women . The diagnosis can take many yearsand the condition can cause debilitating pain and infertility. The disease can be found in many sites throughout the pelvis, in particular the ovaries, pelvic peritoneum, pouch of Douglas (POD), rectum, rectosigmoid, rectovaginal septum (RVS), uterosacral ligaments (USLs), vagina and urinary bladder. Mapping of deeply infiltrating disease is essential to enable the correct counselling regarding treatment modalities (medical or surgical) and risks of surgery, triaging to the correct surgical centre, informing the surgeon in order to correctly plan surgery and enabling other specialities, such as colorectal or urology support, to be organized in advance. Magnetic resonance imaging (MRI) has been used as the main pre-operative imaging modality, but with the correct training and experience transvaginal ultrasound can perform the same role . - Type - Chapter - Information - Gynaecological Ultrasound ScanningTips and Tricks, pp. 121 - 126Publisher: Cambridge University PressPrint publication year: 2020 Ferrero, S, Arena, E, Morando, A, Remorgida, V. Prevalence of newly diagnosed endometriosis in women attending the general practitioner. Int J Gynaecol Obstet 2010;110:203–7.Google Scholar Hadfield, R, Mardon, H, Barlow, D, et al. Delay in the diagnosis of endometriosis: a survey of women from the USA and the UK. Hum Reprod 1996;11(4):878–80.Google Scholar Bazot, M, Lafont, C, Rouzier, R, et al. Diagnostic accuracy of physical examination, transvaginal sonography, rectal endoscopic sonography, and magnetic resonance imaging to diagnose deep infiltrating endometriosis. Fertil Steril 2008;92:1825–33.Google Scholar Hudelist, G, Ballard, K, English, J, et al. Transvaginal sonography vs. clinical examination in the preoperative diagnosis of deep infiltrating endometriosis. Ultrasound Obstet Gynecol 2011;37:480–7.Google Scholar Naftalin, J, Hoo, W, Pateman, K, et al. How common is adenomyosis? A prospective study of prevalence using transvaginal ultrasound in a gynaecology clinic. Hum Reprod 2012;27(12):3432–9.Google Scholar Naftalin, J, Hoo, W, Nunes, N, et al. Association between ultrasound features of adenomyosis and severity of menstrual pain. Ultrasound Obstet Gynecol 2016;47(6),779–83.CrossRefGoogle ScholarPubMed Tailor, A, Jurkovic, D, Bourne, TH, Collins, WP, Campbell, S. Sonographic prediction of malignancy in adnexal masses using an artificial neural network. Br J Obstet Gynaecol 1999;106:21–30.Google Scholar Holland, TK, Yazbek, J, Cutner, A, et al. The value of transvaginal ultrasound in assessing the severity of pelvic endometriosis. Ultrasound Obstet Gynecol 2010;36:241–8.Google Scholar Savelli, L, de Iaco, P, Ghi, T, et al. Transvaginal sonographic appearance of peritoneal pseudocysts. Ultrasound Obstet Gynecol 2004;23:284–8.Google Scholar Savelli, L, Manuzzi, L, Pollastri, P, et al. Diagnostic accuracy and potential limitations of transvaginal sonography for bladder endometriosis. Ultrasound Obstet Gynecol 2009;34:595–600.Google Scholar Pateman, K, Mavrelos, D, Hoo, WL, et al. Visualization of ureters on standard gynecological transvaginal scan: a feasibility study. Ultrasound Obstet Gynecol 2013;41:696–701.Google Scholar Pateman, K, Holland, TK, Knez, J, et al. Should a detailed ultrasound examination of the complete urinary tract be routinely performed in women with suspected pelvic endometriosis? Hum Reprod 2015;30:2802–7.Google ScholarPubMed Block, B. The Practice of Ultrasound: a Step-By-Step Guide to Abdominal Scanning. 2nd ed. Thieme Medical Publishers, 2011.Google Scholar Bosniak, MA. The Bosniak renal cyst classification: 25 years later. Radiology 2012;262:781–5.Google Scholar Fedele, L, Piazzola, E, Raffaelli, R, Bianchi, S. Bladder endometriosis: deep infiltrating endometriosis or adenomyosis? Fertil Steril 1998;69:972–5.Google Scholar Koga, K, Osuga, Y, Yano, T, et al. Characteristic images of deeply infiltrating rectosigmoid endometriosis on transvaginal and transrectal ultrasonography. Hum Reprod 2003;18:1328–33.Google Scholar 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):318–32.Google Scholar Accessibility compliance for the HTML of this chapter is currently unknown and may be updated in the future. 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Condition tags

endometriosisinfertility

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 (20)

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