Endometriosis echocardiography or ultrasound

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Joseph Nasr, M.D.[2], Aravind Kuchkuntla, M.B.B.S[3]

Abdominal ultrasound in a patient with endometriosis is helpful in differentiating endometriosis from other cystic abnormalities. The endometrial lesions have increased vascularity and will demonstrate increased Doppler flow. Transvaginal ultrasound is more sensitive. Multiple international guidelines recommend transvaginal pelvic ultrasound as the initial diagnostic test for patients with pelvic pain and suspected endometriosis.^[1]

• Abdominal ultrasound is helpful in differentiating endometriosis from other cystic abnormalities. The endometrial lesions have increased vascularity and will demonstrate increased Doppler flow.^[2]
• Transvaginal ultrasound is useful in the detection of deeply seated endometriosis and rectosigmoid endometriosis. Transvaginal ultrasound is more sensitive than abdominal ultrasound.^[3]
  • Key features of endometrioma are typically unilocular cysts but may be multilocular, containing thin or thick septations.
• Ultrasound may show mural nodules in the case of endometriosis. If these mural nodules are hyperechoic, these have a high predictive value for endometrioma over non-endometrial cancer.

• Ovarian endometriomas: sensitivity 93% (95% CI, 87%–99%) and specificity 96% (95% CI, 92%–99%) (8 studies; n = 765).^[4]
• Deep endometriosis: sensitivity 79% (95% CI, 69%–89%) (9 studies; n = 934).^[4]
• Superficial peritoneal disease: sensitivity 65% (95% CI, 27%–100%).^[4]

Because ultrasound does not have 100% sensitivity (particularly for superficial peritoneal lesions), absence of ultrasound findings does not exclude endometriosis.^[4]

A Society of Radiologists in Ultrasound consensus describes “augmented pelvic ultrasound” to improve detection of deep endometriosis.^[5]

Key augmented ultrasound features include:

• “Kissing ovaries,” which may suggest deep endometriosis.  
• Absent uterine sliding against the rectosigmoid, which may suggest adhesions and deep endometriosis.^[5]
• In a prospective observational study of 273 patients undergoing laparoscopic surgery, augmented pelvic ultrasound for deep endometriosis had sensitivity 88.4% (95% CI, 83.2%–92.4%) and specificity 78.8% (95% CI, 67.0%–87.9%).^[6]