Endometriosis Detection and Diagnosis

Introduction to Endometriosis Detection

• Standard ultrasound alone is not sufficient to detect all forms of endometriosis, but specialized transvaginal ultrasound protocols performed by experts can identify many forms of endometriosis, particularly endometriomas and deep infiltrating endometriosis, as recommended by the American College of Radiology 1

Characteristics of Endometriosis

• Ovarian Endometriomas appear as adnexal or ovarian masses with homogenous low-level internal echoes, and the presence of echogenic foci in the wall or multilocularity increases the likelihood of endometrioma diagnosis, according to the American College of Radiology 2
• Deep Infiltrating Endometriosis (DIE) can be detected with specialized transvaginal ultrasound protocols when performed by experienced operators, as stated by the American College of Radiology 1
• Rectosigmoid Endometriosis can be detected with specialized TVUS, which has shown superior detection compared to MRI in some studies, as reported by the American College of Radiology 2

Ultrasound Protocols for Endometriosis Detection

• The American College of Radiology recommends an Expanded Protocol TVUS, which includes detailed imaging of uterosacral ligaments, anterior rectosigmoid wall, appendix, and diaphragm with dynamic sliding maneuvers to evaluate organ mobility 1
• Preparation requirements for TVUS include bowel preparation or enema for detection of bowel lesions, and some protocols include 3D ultrasound imaging and saline contrast sonovaginography, as recommended by the American College of Radiology 1
• Expertise requirement for TVUS includes special training with a learning curve of at least 40 examinations, as stated by the American College of Radiology 1

Diagnostic Algorithm and Operator Dependency

• Operator dependency is significant, as studies comparing trained versus untrained operators showed that the modality predicted bowel endometriosis only when performed by trained operators, according to the American College of Radiology 1
• For cases requiring further characterization, MRI pelvis without and with IV contrast may be appropriate, as recommended by the American College of Radiology 1

Limitations and Availability of TVUS

• Standard TVUS has significantly lower sensitivity compared to expanded protocol TVUS studies, as reported by the American College of Radiology 1
• Expanded protocol TVUS studies are not widely available in the United States, as stated by the American College of Radiology 1