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Advances in Imaging for Assessing Pelvic Endometriosis. Diagnostics (Basel) 2022; 12:diagnostics12122960. [PMID: 36552967 PMCID: PMC9777476 DOI: 10.3390/diagnostics12122960] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022] Open
Abstract
In recent years, due to the development of standardized diagnostic protocols associated with an improvement in the associated technology, the diagnosis of pelvic endometriosis using imaging is becoming a reality. In particular, transvaginal ultrasound and magnetic resonance are today the two imaging techniques that can accurately identify the majority of the phenotypes of endometriosis. This review focuses not only on these most common imaging modalities but also on some additional radiological techniques that were proposed for rectosigmoid colon endometriosis, such as double-contrast barium enema, rectal endoscopic ultrasonography, multidetector computed tomography enema, computed tomography colonography and positron emission tomography-computed tomography with 16α-[18F]fluoro-17β-estradiol.
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Deslandes A, Parange N, Childs JT, Osborne B, Panuccio C, Croft A, Bezak E. How long does a transvaginal ultrasound examination for endometriosis take in comparison to a routine transvaginal ultrasound examination? Australas J Ultrasound Med 2022; 25:20-27. [PMID: 35251899 PMCID: PMC8873621 DOI: 10.1002/ajum.12288] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2024] Open
Abstract
INTRODUCTION This study aimed to determine the additional time needed to perform an endometriosis transvaginal ultrasound (eTVUS) compared to routine transvaginal ultrasound (rTVUS). METHODS A retrospective case-control study was performed. The study group included 199 eTVUS performed between September 2019 and September 2020. The control group comprised 105 consecutive rTVUS studies performed in the same time period. The time stamps on the ultrasound images of all cases in both groups were reviewed to determine the time taken to perform each study. Mean, median, minimum and maximum scan times for both groups were calculated as was percentage difference between scan times. A two-tailed, unpaired t-test of the normalised data and a Mann-Whitney U test assessing time difference of scans between two groups were performed with P value <0.05 considered statistically significant. RESULTS Performing eTVUS took significantly longer than rTVUS with increases in the mean (8.4 vs 13.8 min, 64%), median (7 vs 12 min, 71%), minimum (4 vs 7 min, 75%) and maximum (19 vs 42 min, 121%) scan times. The Mann-Whitney U test indicated a statistically significant difference in the median scan times (5.0, CI 4.0-6.0), P < 0.001. An independent t-test of the normalised data revealed a significantly larger mean scan time for eTVUS than rTVUS, Mean = 9.05 95%CI [13.17-4.94], t(302) = 4.327, P < 0.001. R 2 = 0.583. CONCLUSION Endometriosis transvaginal ultrasound added an average 5.4 min to rTVUS, which is statistically significant. For ultrasound departments wanting to offer this technique, doubling the scan time allocated to perform a transvaginal ultrasound (TVUS) is suggested.
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Affiliation(s)
- Alison Deslandes
- Specialist Imaging PartnersNorth AdelaideSouth Australia5006Australia
- Unit of Allied Health and Human PerformanceUniversity of South AustraliaAdelaideSouth Australia5000Australia
| | - Nayana Parange
- Unit of Allied Health and Human PerformanceUniversity of South AustraliaAdelaideSouth Australia5000Australia
| | - Jessie T. Childs
- Unit of Allied Health and Human PerformanceUniversity of South AustraliaAdelaideSouth Australia5000Australia
| | - Brooke Osborne
- Unit of Allied Health and Human PerformanceUniversity of South AustraliaAdelaideSouth Australia5000Australia
| | - Catrina Panuccio
- Specialist Imaging PartnersNorth AdelaideSouth Australia5006Australia
| | - Anthea Croft
- Specialist Imaging PartnersNorth AdelaideSouth Australia5006Australia
| | - Eva Bezak
- Unit of Allied Health and Human PerformanceUniversity of South AustraliaAdelaideSouth Australia5000Australia
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Alfaraj S, Noga H, Allaire C, Williams C, Lisonkova S, Yong PJ, Bedaiwy MA. Negative Sliding Sign during Dynamic Ultrasonography Predicts Low Endometriosis Fertility Index at Laparoscopy. J Minim Invasive Gynecol 2020; 28:249-258.e2. [PMID: 32416264 DOI: 10.1016/j.jmig.2020.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 04/29/2020] [Accepted: 05/03/2020] [Indexed: 10/24/2022]
Abstract
STUDY OBJECTIVE Endometriosis fertility index (EFI) is a robust tool to predict the pregnancy rate in patients with endometriosis who are attempting non-in vitro fertilization conception. However, EFI calculation requires laparoscopy. Newly established imaging techniques such as sliding sign, which is used to diagnose pouch of Douglas obliteration, could provide a promising alternative. The objective of this study was to investigate the practicality of using ultrasound data to predict a low EFI (score ≤6). DESIGN Observational study from a prospective registry (Endometriosis Pelvic Pain Interdisciplinary Cohort, clinicaltrials.gov #NCT02911090). Analyzed data were captured from December 2013 to June 2017. SETTING Tertiary referral center at British Columbia Women's Hospital. PATIENTS We analyzed data for 2583 participants from the Endometriosis Pelvic Pain Interdisciplinary Cohort. In this cross-sectional study, we included 86 women aged <40 years. INTERVENTIONS Dynamic ultrasonography for the sliding sign testing and EFI calculation during laparoscopic surgery. MEASUREMENTS AND MAIN RESULTS Logistic regression was used to obtain receiver operating characteristic area under the curve (AUC) for the prediction models. Significance was p <.05. Patients with a negative sliding sign were older and had severe endometriosis and longer duration of infertility. Patients with a negative sliding sign had significantly lower total EFI scores and lower surgical factors scores than patients with a positive sliding sign. Logistic regression showed that a negative sliding sign and EFI historic factors score can predict an EFI score ≤6 (sensitivity = 87.9%, specificity = 81.1%, AUC = 0.93 [95% confidence interval, 0.88-0.98]). Adding the diagnosis of endometrioma to the previous prediction model resulted in AUC = 0.95 (95% confidence interval, 0.90-0.995), sensitivity = 84.8%, and specificity = 92.5%. CONCLUSION The sliding sign could be a potential alternative to the EFI surgical factors, and it could be used in combination with EFI historic factors and the diagnosis of endometrioma to predict an EFI score ≤6 for patients who are not scheduled for immediate surgery.
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Affiliation(s)
- Sukainah Alfaraj
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, Canada (all authors)
| | - Heather Noga
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, Canada (all authors)
| | - Catherine Allaire
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, Canada (all authors)
| | - Christina Williams
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, Canada (all authors)
| | - Sarka Lisonkova
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, Canada (all authors)
| | - Paul J Yong
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, Canada (all authors)
| | - Mohamed A Bedaiwy
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynecology, University of British Columbia, Vancouver, Canada (all authors)..
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Biscaldi E, Barra F, Ferrero S. Magnetic Resonance Enema in Rectosigmoid Endometriosis. Magn Reson Imaging Clin N Am 2020; 28:89-104. [DOI: 10.1016/j.mric.2019.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Espada M, Alvarez-Moreno E, Jimenez de la Pena M, Munoz Capio V, Reid S, Condous G. Imaging techniques in endometriosis. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2018. [DOI: 10.1177/2284026518773215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Endometriosis is a common gynecological condition affecting up to 15% of the general female population. Here, we present a systematic review of imaging techniques of endometriosis. The aim of this review is to determine the most accurate site-specific preoperative diagnostic tools in order to map, locate, evaluate the extension, and stage the disease. There are important reasons to stage endometriosis: to create a common language, to enable specificity of diagnosis, standardize comparisons, and to facilitate research applications. The requirements of an ideal endometriosis classification system are that it be empirically and scientifically based, be of general consensus, have unambiguous definition of terms, be comprehensive in all cases, have a simple translation from anatomic features to verbal description, reflect disease, predict fertility, predict pain relief, be useful to guide treatment, indicate risk of recurrence, identify clinical situations in which it does not apply, be simple to calculate, and be easy to communicate to women. An extensive search of papers regarding imaging techniques in endometriosis was performed in Pubmed from January 1992 to February 2018, including original peer-reviewed papers, reviews, and international guidelines.
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Affiliation(s)
- Mercedes Espada
- Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Sydney Medical School Nepean, Nepean Hospital, The University of Sydney, Penrith, NSW, Australia
| | | | | | | | - Shannon Reid
- Department of Obstetrics and Gynaecology, Wollongong Hospital, Wollongong, NSW, Australia
| | - George Condous
- Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Sydney Medical School Nepean, Nepean Hospital, The University of Sydney, Penrith, NSW, Australia
- OMNI Ultrasound & Gynaecological Care, Centre for Women’s Ultrasound and Early Pregnancy, Sydney, NSW, Australia
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6
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Robinson AJ, Rombauts L, Ades A, Leong K, Paul E, Piessens S. Poor sensitivity of transvaginal ultrasound markers in diagnosis of superficial endometriosis of the uterosacral ligaments. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2018. [DOI: 10.1177/2284026518767259] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: This study aims to evaluate the use of transvaginal ultrasound in predicting superficial endometriosis near the uterosacral ligaments, in women with symptoms of endometriosis. Methods: This was a prospective observational pilot study in which women with symptoms of endometriosis underwent detailed pre-operative transvaginal ultrasound to assess the uterosacral ligament area for thickening (‘white line sign’), tenderness and small hypoechoic nodules. Women with deep infiltrating endometriosis were excluded. The test characteristics of transvaginal ultrasound were reported using histologically or visually proven endometriosis near the ipsilateral uterosacral ligament as a reference standard. Results: In 81 patients who underwent pre-operative transvaginal ultrasound and laparoscopy, no marker had appropriate test characteristics for a diagnostic or screening test for endometriosis near the ipsilateral uterosacral ligament when used alone. The presence of a small hypoechoic nodule on the white line had the highest specificity of the three markers, at 82% (95% confidence interval 66%–92%). Quantitative measurement of the white line also achieved a high specificity of ≥96% using a cut-off of 5.8 and 6.1 mm, on the left and right sides, respectively. Conclusion: Transvaginal ultrasound of the uterosacral ligament area using the three proposed markers is not a clinically useful screening test for superficial endometriosis near the uterosacral ligaments. A grossly thickened white line (≥5.8 mm) and/or the presence of small hypoechoic nodules are highly specific findings for superficial endometriosis near the uterosacral ligaments and may prompt surgical management.
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Affiliation(s)
- Alice J Robinson
- Department of Obstetrics and Gynaecology, Monash Health, Clayton, VIC, Australia
- Camberwell Ultrasound for Women, Hawthorn East, VIC, Australia
| | - Luk Rombauts
- Department of Obstetrics and Gynaecology, Monash Health, Clayton, VIC, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
- Monash IVF Group, Richmond, VIC, Australia
| | - Alex Ades
- Department of Obstetrics and Gynaecology, The Royal Women’s Hospital, Parkville, VIC, Australia
- Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, VIC, Australia
| | - Kenneth Leong
- Monash IVF Group, Richmond, VIC, Australia
- Borderless Healthcare Group, Shanghai, China
| | - Eldho Paul
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia
| | - Sofie Piessens
- Department of Obstetrics and Gynaecology, Monash Health, Clayton, VIC, Australia
- Camberwell Ultrasound for Women, Hawthorn East, VIC, Australia
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Sibal M. Gel Sonovaginography: A New Way of Evaluating a Variety of Local Vaginal and Cervical Disorders. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:2699-2715. [PMID: 27821656 DOI: 10.7863/ultra.16.01068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 02/15/2016] [Accepted: 03/09/2016] [Indexed: 06/06/2023]
Abstract
Gel sonovaginography is a new way of assessing local cervical and vaginal disorders, in which regular transvaginal sonography is known to have limitations. In gel sonovaginography, 20 mL of ultrasound gel is instilled into the vagina, followed by examination with a transvaginal transducer. In a study involving 28 women with known or suspected disorders such as cervical and vaginal cancer, cervical polyps, vaginal septa, and deep infiltrating endometriosis, a substantial improvement in visualization and assessment of local lesions and structures was noted with gel sonovaginography. This simple technique appears to be valuable for accurate diagnosis of local cervical and vaginal disorders.
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Affiliation(s)
- Mala Sibal
- Department of Fetal Medicine and Obstetric and Gynecologic Ultrasound, Manipal Hospital, Bangalore, India.
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Guerriero S, Condous G, van den Bosch T, Valentin L, Leone FPG, Van Schoubroeck D, Exacoustos C, Installé AJF, Martins WP, Abrao MS, Hudelist G, Bazot M, Alcazar JL, Gonçalves MO, Pascual MA, Ajossa S, Savelli L, Dunham R, Reid S, Menakaya U, Bourne T, Ferrero S, Leon M, Bignardi T, Holland T, Jurkovic D, Benacerraf B, Osuga Y, Somigliana E, Timmerman D. 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 IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2016; 48:318-332. [PMID: 27349699 DOI: 10.1002/uog.15955] [Citation(s) in RCA: 434] [Impact Index Per Article: 54.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 04/11/2016] [Accepted: 04/25/2016] [Indexed: 06/06/2023]
Abstract
The IDEA (International Deep Endometriosis Analysis group) statement is a consensus opinion on terms, definitions and measurements that may be used to describe the sonographic features of the different phenotypes of endometriosis. Currently, it is difficult to compare results between published studies because authors use different terms when describing the same structures and anatomical locations. We hope that the terms and definitions suggested herein will be adopted in centers around the world. This would result in consistent use of nomenclature when describing the ultrasound location and extent of endometriosis. We believe that the standardization of terminology will allow meaningful comparisons between future studies in women with an ultrasound diagnosis of endometriosis and should facilitate multicenter research. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- S Guerriero
- Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, Monserrato, Cagliari, Italy
| | - G Condous
- Acute Gynaecology, Early Pregnancy & Advanced Endosurgery Unit, Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Penrith, NSW, Australia
| | - T van den Bosch
- Department Obstetrics and Gynecology, University Hospitals, KU Leuven, Leuven, Belgium and Department of Obstetrics and Gynecology, Tienen Regional Hospital, Tienen, Belgium
| | - L Valentin
- Lund University, Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden
| | - F P G Leone
- Department of Obstetrics and Gynecology, Clinical Sciences Institute L. Sacco, Milan, Italy
| | - D Van Schoubroeck
- Department Obstetrics and Gynecology, University Hospitals, KU Leuven, Leuven, Belgium and Department of Obstetrics and Gynecology, Tienen Regional Hospital, Tienen, Belgium
| | - C Exacoustos
- Department of Biomedicine and Prevention, Obstetrics and Gynecological Clinic, Faculty of Medicine, University of Rome 'Tor Vergata', Rome, Italy and Ospedale Generale S. Giovanni Calibita Fatebene Fratelli, Rome, Italy
| | - A J F Installé
- KU Leuven, Department of Electrical Engineering (ESAT), STADIUS, Center for Dynamical Systems, Signal Processing and Data Analytics, Leuven, Belgium and iMinds Medical IT, Leuven, Belgium
| | - W P Martins
- Department of Obstetrics and Gynecology, Ribeirao Preto Medical School, University of Sao Paulo, Sao Paulo, Brazil
| | - M S Abrao
- Endometriosis Division, Obstetrics and Gynecological Department, Sao Paulo University, Sao Paulo, Brazil
| | - G Hudelist
- Hospital St John of God Johannes, Vienna, Austria
| | - M Bazot
- Department of Radiology, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris and Université Pierre et Marie Curie, Paris, France
| | - J L Alcazar
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra School of Medicine, University of Navarra, Pamplona, Spain
| | - M O Gonçalves
- Clinica Medicina da Mulher and RDO Medicina Diagnóstica, Sao Paulo, Brazil
| | - M A Pascual
- Department of Obstetrics, Gynaecology and Reproduction, Institut Universitari Dexeus, Barcelona, Spain
| | - S Ajossa
- Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, Monserrato, Cagliari, Italy
| | - L Savelli
- Gynecology and Early Pregnancy Ultrasound Unit, S. Orsola - Malpighi Hospital, University of Bologna, Bologna, Italy
| | - R Dunham
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - S Reid
- Department of Obstetrics and Gynaecology, Wollongong Hospital, Wollongong, NSW, Australia
| | - U Menakaya
- Department of Obstetrics and Gynaecology Calvary Public Hospital & JUNIC Specialist Imaging & Women's Center, Canberra, Australia
| | - T Bourne
- Queen Charlotte's & Chelsea Hospital, Imperial College, London, UK
| | - S Ferrero
- Unit of Obstetrics and Gynaecology, IRCCS AOU San Martino - IST, Genova, Italy and Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genova, Genova, Italy
| | - M Leon
- Ultrasound Unit, Department of Gynaecology and Obstetrics, Clinica Indisa, Santiago, Chile
| | - T Bignardi
- Department of Obstetrics and Gynecology, Azienda, Ospedaliera Niguarda Ca' Granda, Milan, Italy
| | - T Holland
- Institute for Women's Health, University College Hospital, London, UK
| | - D Jurkovic
- Institute for Women's Health, University College Hospital, London, UK
| | - B Benacerraf
- Department of Obstetrics, Gynecology and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Y Osuga
- Department of Obstetrics and Gynecology, The University of Tokyo, Tokyo, Japan
| | - E Somigliana
- Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - D Timmerman
- Department Obstetrics and Gynecology, University Hospitals, KU Leuven, Leuven, Belgium and Department of Obstetrics and Gynecology, Tienen Regional Hospital, Tienen, Belgium
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Menakaya UA, Rombauts L, Johnson NP. Diagnostic laparoscopy in pre-surgical planning for higher stage endometriosis: Is it still relevant? Aust N Z J Obstet Gynaecol 2016; 56:518-522. [DOI: 10.1111/ajo.12505] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 06/13/2016] [Indexed: 01/24/2023]
Affiliation(s)
- Uche A. Menakaya
- Department of Obstetrics and Gynecology; Calvary Public Hospital; ACT Australia
- JUNIC Specialist Imaging and Women's Center; Canberra ACT Australia
| | - Luk Rombauts
- Monash University; Melbourne Vic. Australia
- Monash IVF; Melbourne Vic. Australia
- Reproductive Medicine; Monash Health; Clayton Vic. Australia
| | - Neil P. Johnson
- Robinson Research Institute; University of Adelaide; Adelaide SA Australia
- University of Auckland; Auckland New Zealand
- Repromed and Auckland Gynecology Group; Auckland New Zealand
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Reid S, Bignardi T, Lu C, Lam A, Condous G. The use of intra-operative saline sonovaginography to define the rectovaginal septum in women with suspected rectovaginal endometriosis: a pilot study. Australas J Ultrasound Med 2015; 14:4-9. [PMID: 28191113 PMCID: PMC5024895 DOI: 10.1002/j.2205-0140.2011.tb00116.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objectives: The aim of this study was to perform saline sonovaginography (SVG) in women with suspected rectovaginal endometriosis (RVE) in order to establish the thickness of the rectovaginal septum (RVS) in this population and to predict the presence or absence of RVE. Methods: Prospective observational pilot study. Women undergoing laparoscopy for possible endometriosis on the basis of history or clinical examination were offered to participate in the study. All women underwent saline SVG during general anesthesia just prior to their laparoscopy. RVS nodules were visualised as hypoechoic lesions of various shapes. The sonologist predicted whether or not a nodule was present in the retrocervical area or in the RVS. The thickness of the posterior vaginal wall ± RVS was then taken at three points in the mid-sagittal plane: at the posterior fornix (retrocervical area), at the middle third of the vagina (upper RVS) and just above the perineal body (lower RVS). The diagnosis of RVE was established using the gold standards of laparoscopy and histological confirmation. The RVS thickness was then compared between women with RVE and the absence of RVE. Results: Twenty-three women were enrolled in the study. Mean age was 38 years (33-44 years). A history of endometriosis was present in 72.7% (8/11). RVE was confirmed in 17.4% (4/23). Visualisation of a hypoechoic nodule at saline SVG demonstrated sensitivity and specificity of 75% and 95%, respectively. All rectovaginal nodules were located in the retrocervical region. Mean diameter (SD) of RVE nodules was 27.3 (± 9.4) mm. Mean thickness of vaginal wall ± RVS at the posterior fornix, at the middle third of the vagina and just above the perineal body was 5.1, 1.4 and 4.0 mm, respectively. These measurements were not significantly different in the presence of a rectovaginal nodule. Conclusions: Using saline SVG, we have established the mean RVS thickness in a small group of women with suspected RVE. Although the numbers are small, there was no correlation between RVS thickness and presence of RVE. The visualisation of hypoechoic lesions at saline SVG seems to be the best ultrasonographic predictor for RVE. SVG is a valuable pre-operative tool for the assessment of RVS and for the prediction of RVE, which allows for the mapping and planning of advanced endometriosis surgery.
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Affiliation(s)
- Shannon Reid
- Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit Nepean Centre for Perinatal Care Nepean Clinical School University of Sydney Nepean Hospital Penrith NSW Australia
| | - Tommaso Bignardi
- Acute Gynaecology, Early Pregnancy and Advanced Endosurgery UnitNepean Centre for Perinatal Care Nepean Clinical School University of Sydney Nepean Hospital PenrithNSWAustralia; Omni Gynaecological CareCentre for Women's Ultrasound and Early Pregnancy St LeonardsNSWAustralia
| | - Chuan Lu
- Department of Computer Sciences University of Wales Aberystwyth United Kingdom
| | - Alan Lam
- Centre for Advanced Reproductive Endosurgery St Leonards NSW Australia
| | - George Condous
- Acute Gynaecology, Early Pregnancy and Advanced Endosurgery UnitNepean Centre for Perinatal Care Nepean Clinical School University of Sydney Nepean Hospital PenrithNSWAustralia; Omni Gynaecological CareCentre for Women's Ultrasound and Early Pregnancy St LeonardsNSWAustralia
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11
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Menakaya UA, Adno A, Lanzarone V, Johnson NP, Condous G. Integrating the concept of advanced gynaecological imaging for endometriosis. Aust N Z J Obstet Gynaecol 2015; 55:409-12. [PMID: 26426947 DOI: 10.1111/ajo.12403] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Uche A. Menakaya
- Calvary Health Care; Calvary Public Hospital; Bruce Australian Capital Territory Australia
- JUNIC Specialist Imaging and Women's Centre; Charnwood Australian Capital Territory Australia
| | - Alan Adno
- Sydney South West Area Health Service; Women Children and Adolescent Health Liverpool Hospital; Sydney New South Wales Australia
| | | | - Neil P. Johnson
- Robinson Research Institute; University of Adelaide; Adelaide South Australia Australia
- Repromed Auckland and Fertility Plus; University of Auckland; Auckland New Zealand
| | - George Condous
- Acute Gynaecology; Early Pregnancy and Advanced Endosurgery Unit; Nepean Medical School; Nepean Hospital; University of Sydney; Kingswood New South Wales Australia
- OMNI Gynaecological Care; Centre for Women's Ultrasound and Early Pregnancy; St Leonards Sydney New South Wales Australia
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12
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Menakaya U, Reid S, Infante F, Condous G. Systematic evaluation of women with suspected endometriosis using a 5-domain sonographically based approach. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:937-947. [PMID: 26014312 DOI: 10.7863/ultra.34.6.937] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In recent years, knowledge has evolved regarding the role of transvaginal sonography in the assessment of the pouch of Douglas status and the preoperative prediction of extraovarian endometriosis in specific locations. Despite these advances in transvaginal sonography, the challenge of developing a comprehensive, cost-effective, and reproducible preoperative classification system for endometriosis remains. Critical to this classification system should be a sonographically based evaluation protocol that is systematic, evidence based, and reproducible with clearly defined end points. To date, no structured evaluation protocol exists for the assessment of the pelvis in women with suspected endometriosis. In this article, we propose a domain-based evaluation protocol for the assessment of women with suspected endometriosis using transvaginal sonography.
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Affiliation(s)
- Uche Menakaya
- Acute Gynecology, Early Pregnancy, and Advanced Endosurgery Unit, Nepean Medical School, Nepean Hospital, University of Sydney, Kingswood, New South Wales, Australia (U.M., S.R., F.I., G.C.); and OMNI Gynecological Care, Center for Women's Ultrasound and Early Pregnancy, St Leonards, Sydney, New South Wales, Australia (G.C.).
| | - Shannon Reid
- Acute Gynecology, Early Pregnancy, and Advanced Endosurgery Unit, Nepean Medical School, Nepean Hospital, University of Sydney, Kingswood, New South Wales, Australia (U.M., S.R., F.I., G.C.); and OMNI Gynecological Care, Center for Women's Ultrasound and Early Pregnancy, St Leonards, Sydney, New South Wales, Australia (G.C.)
| | - Fernando Infante
- Acute Gynecology, Early Pregnancy, and Advanced Endosurgery Unit, Nepean Medical School, Nepean Hospital, University of Sydney, Kingswood, New South Wales, Australia (U.M., S.R., F.I., G.C.); and OMNI Gynecological Care, Center for Women's Ultrasound and Early Pregnancy, St Leonards, Sydney, New South Wales, Australia (G.C.)
| | - George Condous
- Acute Gynecology, Early Pregnancy, and Advanced Endosurgery Unit, Nepean Medical School, Nepean Hospital, University of Sydney, Kingswood, New South Wales, Australia (U.M., S.R., F.I., G.C.); and OMNI Gynecological Care, Center for Women's Ultrasound and Early Pregnancy, St Leonards, Sydney, New South Wales, Australia (G.C.)
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13
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Menakaya U, Reid S, Infante F, Condous G. The 'sliding sign' in conjunction with sonovaginography: is this the optimal approach for the diagnosis of Pouch of Douglas obliteration and posterior compartment deep infiltrating endometriosis? Australas J Ultrasound Med 2013; 16:118-123. [PMID: 28191185 PMCID: PMC5029996 DOI: 10.1002/j.2205-0140.2013.tb00099.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction: Endometriosis is a chronic peritoneal disease that may progress as a deep infiltrating lesion involving the posterior compartment of the pelvis. Efforts to improve pre-operative knowledge of the location and extent of these lesions have resulted in the development of Transvaginal ultrasound (TVS) as the first-line imaging modality for extra-ovarian endometriosis. However, various techniques of TVS have been described in the literature for this purpose. Methods: In this review we will detail the evolution of TVS as the primary imaging modality in the pre-operative diagnosis of posterior compartment deep infiltrating endometriosis (DIE). We will also discuss the potential of an emerging new real-time diagnostic ultrasound-based technique known as the 'sliding sign' in combination with office gel sonovaginography for the pre-operative diagnosis of Pouch of Douglas obliteration and posterior compartment DIE. Conclusion: Implementation of the new real-time dynamic, reproducible and simple 'sliding sign' in conjunction with SVG has the potential to challenge the current concept that traditional laparoscopy is the 'gold standard' modality for the diagnosis of women with posterior compartment DIE.
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Affiliation(s)
- Uche Menakaya
- Acute Gynaecology Early Pregnancy and Advanced Endosurgery Unit Nepean Medical School Nepean Hospital University of Sydney Kingswood New South Wales Australia
| | - Shannon Reid
- Acute Gynaecology Early Pregnancy and Advanced Endosurgery Unit Nepean Medical School Nepean Hospital University of Sydney Kingswood New South Wales Australia
| | - Fernando Infante
- Acute Gynaecology Early Pregnancy and Advanced Endosurgery Unit Nepean Medical School Nepean Hospital University of Sydney Kingswood New South Wales Australia
| | - George Condous
- Acute GynaecologyEarly Pregnancy and Advanced Endosurgery UnitNepean Medical SchoolNepean HospitalUniversity of SydneyKingswoodNew South WalesAustralia; OMNI GynaecologicalCare Centre for Women's Ultrasound and Early Pregnancy St LeonardsSydneyNew South WalesAustralia
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14
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Reid S, Lu C, Casikar I, Mein B, Magotti R, Ludlow J, Benzie R, Condous G. The prediction of pouch of Douglas obliteration using offline analysis of the transvaginal ultrasound 'sliding sign' technique: inter- and intra-observer reproducibility. Hum Reprod 2013; 28:1237-46. [DOI: 10.1093/humrep/det044] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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