Indirect and atypical imaging signals of endometriosis: A wide range of manifestations

Abstract

Background: Whilst some imaging signs of endometriosis are common and widely accepted as ‘typical’, a range of ‘subtle’ signs could be present in imaging studies, presenting an opportunity to the radiologist and the surgeon to aid the diagnosis and facilitate preoperative surgical planning. Objective: To summarise and analyse the current information related to indirect and atypical signs of endometriosis by ultrasound (US) and magnetic resonance imaging (MRI). Methods: Through the use of PubMed and Google scholar, we conducted a comprehensive review of available articles related to the diagnosis of indirect signs in transvaginal US and MRI. All abstracts were assessed and the studies were finally selected by two authors. Results: Transvaginal US is a real time dynamic exploration, that can reach a sensitivity of 79-94% and specificity of 94%. It allows evaluation of normal sliding between structures in different compartments, searching for adhesions or fibrosis. MRI is an excellent tool that can reach a sensitivity of 94% and specificity of 77% and allows visualisation of the uterus, bowel loop deviation and peritoneal inclusion cysts. It also allows the categorisation and classification of ovarian cysts, rectovaginal and vesicovaginal septum obliteration, and small bowel endometriotic implants. Conclusion: The use of an adequate mapping protocol with systematic evaluation and the reporting of direct and indirect signs of endometriosis is crucial for detailed and safe surgical planning.

Short-term outcomes in patients undergoing laparoscopic surgery for deep infiltrative endometriosis with rectal involvement: a single-center experience of 168 cases

“…Recently, Vigueras Smith et al [ 21 ] conducted a literature review that included retrospective studies and systematic analyses specifically addressing the issue of anastomotic leakage following DE surgery. These authors provided general recommendations for temporary bowel diversion in those deemed at higher risk of anastomotic leakage.…”

Endometriosis-Related Ovarian Cancer: Where Are We Now? A Narrative Review towards a Pragmatic Approach

“…Overall, MRI exhibits an accuracy of 83-91% in distinguishing between benign and malignant ovarian masses. The staging accuracy of MRI is comparable to that of conventional CT [43]. Due to its superior resolution in soft tissue contrast, MRI can precisely identify the invasion of pelvic organs.…”

“…In patients with endometriotic cysts, preoperative suspicion of malignant transformation is essential to prevent the intraoperative dissemination of malignant cells. To achieve this goal, a considerable level of proficiency in transvaginal sonography (TVS) is necessary, as it remains the most advantageous and easily accessible approach for preoperative evaluation, being a real time dynamic assessment with a sensitivity ranging from 79 to 94% and a specificity of 94% [43]. MRI may provide supplementary information in specific instances, but it is not a routine method for the preoperative evaluation of endometrioma.…”