Rectovaginal Examination, Transvaginal Ultrasonography, and Magnetic Resonance Imaging as Diagnostic Tools for Identifying Deep Infiltrating Endometriosis Nodules

Florencia Wirawan, Luky S Marwali, Refni Muslim, Eva Roria Silalahi, Harjo S. Bayuaji, Astri Anindita
In: Indonesian Journal of Obstetrics and Gynecology · 2018 · pp. 167 · doi:10.32771/inajog.v6i3.782 · W2889661076
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This study compared rectovaginal examination, transvaginal ultrasonography, and MRI for diagnosing deep infiltrating endometriosis, finding TVUS best for uterosacral ligaments and rectovaginal nodules, while MRI excelled at bowel and urological DIE.

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

This prospective longitudinal study evaluated and compared rectovaginal examination (RVT), transvaginal ultrasonography (TVUS), and magnetic resonance imaging (MRI) for identifying deep infiltrating endometriosis (DIE) nodules in 31 women referred for surgical management. DIE were present in 95.45% of participants, most commonly at the uterosacral ligaments, and diagnostic performance was quantified using sensitivity, specificity, PPV, NPV, and accuracy by nodule location. TVUS showed the highest overall accuracy, particularly for uterosacral ligament and rectovaginal areas, while MRI performed better for rectosigmoid-colon (bowel) and bladder-ureteral DIE, and RVT had good PPV but poor NPV and weaker detection of anterior DIE; a key limitation explicitly implied by the design and conclusions is restricted generalizability due to the small surgical-referral sample. This paper is centrally about endometriosis — it directly compares RVT, TVUS, and MRI for diagnosing deep infiltrating endometriosis nodules by anatomical site.

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Abstract

Objective: To investigate the comparison between rectovaginal examination (RVT), transvaginal ultrasonography (TVUS) and magnetic resonance imaging (MRI) as diagnostic tools for identifying various Deep Infiltrating Endometriosis (DIE). Methods: Prospective longitudinal study was done involving 31 women referred for surgical management of DIE. Calculation of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of RVT, TVUS and MRI for DIE were recorded. Results: The mean age was 35.1 years. DIE were present in 95.45% of women which commonly located at uterosacral ligaments (58.33%), followed by rectovaginal (16,67%), rectosigmoid- colon (16.67%) and bladder-ureter (8.3%). TVUS had the best accuracy (RVT 50.24%; TVUS 88.85%; MRI 75.77%) among other diagnostic tools for nodules located at uterosacral ligaments (RVT 52.63%; TVUS 87%; MRI 40%) and rectovaginal (RVT 76.75%; TVUS 93.34%; MRI 80%), but it poorly identified nodules located at rectosigmoid (RVT 20%; TVUS 65.56%; MRI 88.75%) and bladder-ureteral area (RVT 50.44%; TVUS 87.66%; MRI 93.55%). RVT had good PPV (88.89%) but bad NPV (32.01%) profile, made it worth to be a screening diagnostic tool. Conclusion: RVT was a good screening diagnostic tools as it could be done easily but was weak in diagnosing anterior DIE. TVUS gave a better diagnosis rates on DIE located at sacrouterina ligaments and rectovaginal area whereas MRI did better on bowel DIE (rectosigmoid- colon area) and urological DIE (bladder-ureteral area). Keywords: deep infiltrating endometriosis, magnetic resonance imaging, tranvaginal ultrasonography
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Objective

To investigate the comparison between rectovaginal examination (RVT), transvaginal ultrasonography (TVUS) and magnetic resonance imaging (MRI) as diagnostic tools for identifying various Deep Infiltrating Endometriosis (DIE).

Methods

Prospective longitudinal study was done involving 31 women referred for surgical management of DIE. Calculation of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of RVT, TVUS and MRI for DIE were recorded.

Results

The mean age was 35.1 years. DIE were present in 95.45% of women which commonly located at uterosacral ligaments (58.33%), followed by rectovaginal (16,67%), rectosigmoid- colon (16.67%) and bladder-ureter (8.3%). TVUS had the best accuracy (RVT 50.24%; TVUS 88.85%; MRI 75.77%) among other diagnostic tools for nodules located at uterosacral ligaments (RVT 52.63%; TVUS 87%; MRI 40%) and rectovaginal (RVT 76.75%; TVUS 93.34%; MRI 80%), but it poorly identified nodules located at rectosigmoid (RVT 20%; TVUS 65.56%; MRI 88.75%) and bladder-ureteral area (RVT 50.44%; TVUS 87.66%; MRI 93.55%). RVT had good PPV (88.89%) but bad NPV (32.01%) profile, made it worth to be a screening diagnostic tool.

Conclusion

RVT was a good screening diagnostic tools as it could be done easily but was weak in diagnosing anterior DIE. TVUS gave a better diagnosis rates on DIE located at sacrouterina ligaments and rectovaginal area whereas MRI did better on bowel DIE (rectosigmoid- colon area) and urological DIE (bladder-ureteral area).

Keywords

deep infiltrating endometriosis, magnetic resonance imaging, tranvaginal ultrasonography

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Condition tags

endometriosisdie_deep_infiltrating

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