Silvia Ajossa, Anna Maria Paoletti, Nicoletta Garau, Valerio Mais, Bruno Piras, Marta Gerada, Enrico Silvetti, Marisa Orrù, Lucia Floris, Gian Benedetto Melis
Deep endometriosis,laparoscopy,transvaginal ultrasonography
Citation Information :
Ajossa S, Paoletti AM, Garau N, Mais V, Piras B, Gerada M, Silvetti E, Orrù M, Floris L, Melis GB. Ultrasound in the Diagnosis of Deep Endometriosis. Donald School J Ultrasound Obstet Gynecol 2009; 3 (1):15-20.
Deep pelvic endometriosis is defined as subperitoneal infiltration of endometrial implants in the uterosacral ligaments, rectum, rectovaginal septum, vagina, or bladder. Although laparoscopy and biopsy remain the gold standard for diagnosis, transvaginal ultrasonography should be considered as the first-line procedure because of its high diffusion and relatively low cost and discomfort. We analyzed in the present review the diagnostic capability of transvaginal ultrasonography in the detection of presence of deep endometriosis in some specific pelvic localizations such as bowel, uterosacral ligaments, rectovaginal septum and/or vagina. We also analyzed the few studies performed in the evaluation of bladder endometriosis. Although some studies are controversial, transvaginal ultrasonography seems to be an accurate technique in the identifications of deep endometriosis in several pelvic locations but a specific training of the operators is suggested.
Suggestive evidence that pelvic endometriosis is a progressive disease, whereas deeply infiltrating endometriosis is associated with pelvic pain. Fertil Steril 1991;55:759-65.
Results and role of rectal endoscopic ultrasonography for patients with deep pelvic endometriosis. Hum Reprod. 1998;13:2266-70.
Characteristic images of deeply infiltrating rectosigmoid endometriosis on transvaginal and transrectal ultrasonography. Hum Reprod. 2003;18:1328-33.
Transvaginal sonography and rectal endoscopic sonography for the assessment of pelvic endometriosis: a preliminary comparison. Hum Reprod 2003;18:1686-92.
Accuracy of transvaginal sonography and rectal endoscopic sonography in the diagnosis of deep infiltrating endometriosis. Ultrasound Obstet. Gynecol 2007;30:994-1001.
Diagnostic accuracy of physical examination, transvaginal sonography, rectal endoscopic sonography, and magnetic resonance imaging to diagnose deep infiltrating endometriosis. Fertil Steril 2008 Nov 17.
Comparison between clinical examination, transvaginal sonography and magnetic resonance imaging for the diagnosis of deep endometriosis. Hum Reprod 2007;22:3092-97.
Does transvaginal ultrasonography combined with water-contrast in the rectum aid in the diagnosis of rectovaginal endometriosis infiltrating the bowel? Hum Reprod 2008;23:1069-75.
“Tenderness-guided” transvaginal ultrasonography: A new method for the detection of deep endometriosis in patients with chronic pelvic pain. Fertil e Steril 2007;88:1293-97.
Diagnostic value of transvaginal “tenderness-guided” ultrasonography for the prediction of location of deep endometriosis Hum Reprod 2008;23:2452-57.
Evaluation of endometriosis in uterosacral ligaments by transrectal ultrasonography. Hum Reprod 1996;11:2014-17.
Transrectal ultrasonography in the assessment of rectovaginal endometriosis. Obstet Gynecol 1998;91:444-48.
Diagnostic accuracy of transvaginal sonography for deep pelvic endometriosis. Ultrasound Obstet Gynecol 2004;24: 180-85.
Sonovaginography is a new technique for assessing rectovaginal endometriosis. Fertil Steril 2003;79:1023-27.
Comparison of magnetic resonance imaging and transvaginal ultrasonography in diagnosing bladder endometriosis. J Am Assoc Gynecol Laparosc 2002;9:15-23.
Preoperative assessment of bladder endometriosis. Hum Reprod 1997;12:2519-22.
Laparoscopic excision of posterior vaginal fornix in the treatment of patients with deep endometriosis without rectum involvement: Surgical treatment and long-term followup. Hum Reprod 200; 21:1629-34.
Time elapsed from onset of symptoms to diagnosis of endometriosis in a cohort study of Brazilian women. Hum Reprod 2003;18:756-59.
Diagnostic delay in women with pain and endometriosis. Acta Obstet Gynecol Scand 2003;82:649-53.
Endometriosis: current and future medical therapies. Best Pract Res Clin Obstet Gynaecol 2008;22:275-306.