Diagnosis of endometriosis 2^nd part – Ultrasound diagnosis of endometriosis (adenomyosis, endometriomas, adhesions) in the community

Czech version

Authors: T. Indrielle-Kelly ^1,2; F. Frühauf ¹; A. Burgetová ¹; M. Fanta ¹; D. Fischerová ¹
Authors‘ workplace: Gynekologicko-porodnická klinika 1. LF UK a VFN, Praha, přednosta prof. MUDr. A. Martan, DrSc. ¹; Department of Gynaecology and Obstetrics, Burton Hospitals NHS, United Kingdom, Clinical Director Mr. J. Hollingworth ²
Published in: Ceska Gynekol 2019; 84(4): 260-268
Category:

Overview

Objective: To summarise the current knowledge and trends in the basic ultrasound diagnosis of adenomyosis, endometroid cysts and pelvic adhesions.

Design: Review article.

Setting: Centre for diagnostics and treatment of endometriosis and Gynecologic Oncology Centre, Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Department of Gynaecology and Obstetrics, Burton Hospitals NHS, United Kingdom.

Methods: Literature review.

Results: Endometriosis is a relatively common disease, which often escapes timely diagnosis, although sonographic features of adenomyosis, endometriomas and pelvic adhesions can be easily assessed on the basic ultrasound examination. Endometriomas are ovarian cysts in a premenopausal patient with ground glass echogenicity of the cyst fluid, one to four locules and no papilary projections with detectable blood flow. Adenomyosis is characterised by an asymmetrical thickening of the myometrium due to an ill-defined myometrial lesion with fan-shaped shadowing, non-uniform echogenicity with myometrial cysts, hyperechogenic islands, hyperechogenic subendometrial lines and buds with an irregular or interrupted junctional zone, and translesional vascularity containing vessels crossing the leasion perpendicular to the endometrium. Pelvic adhesions can be detected using dynamic aspect of ultrasound examination demonstrating negative sliding sign of the uterus and/or ovaries against surrounding tissue planes and site-specific tenderness. Distorted pelvic anatomy (the presence of uterine ‚question mark sign‘ and/or ‚kissing ovaries‘) is another sign of adhesions.

Conclusion: First step in basic transvaginal ultrasound is visualisation of the uterus and ovaries, assessment of their mobility and tenderness during examination. Knowledge of the characteristic ultrasound features of adenomyosis, endometriomas and adhesions enables timely diagnosis of endometriosis by the community gynecologist and prompt referral to the endometriosis centre.

Keywords:

Endometriosis – ultrasound – endometrioma – adenomyosis – deep endometriosis

Sources

1. Acar, S., Millar, E., Mitkova, M., Mitkov, V. Value of ultrasound shear wave elastography in the diagnosis of adenomyosis. Ultrasound, 2016, 24(4), p. 205–213.

2. Basak, S., Saha, A. Adenomyosis: Still largely under-diagnosed. J Obstet Gynaecol., 2009, 29(6), p. 533–535.

3. Bazot, M., Cortez, A., Darai, E. Ultrasonography compared with magnetic resonance imaging for the diagnosis of adenomyosis: correlation with histopathology. Hum Reprod, 2001, 16, p. 2427–2433.

4. Buis, CC., van Leeuwen, FE., Mooij, TM., et al. Increased risk of ovarian cancer and borderline ovarian tumours in subfertile women with endometriosis. Hum Reprod., 2013, 28(12), p. 3358–3569.

5. Di Donato, N., Montanari, G., Benfenati, A., et al. Prevalence of adenomyosis in women undergoing surgery for endometriosis. Eur J Obstet Gynecol Reprod Biol, 2014, 181, p. 289–293.

6. Di Spiezio Sardo, A., Calagna, G., Santangelo, F., et al. The role of hysteroscopy in the diagnosis and treatment of adenomyosis. BioMed Research International [online] 2017 [cit. 16.1.2019] DOI 10.1155/2017/2518396.

7. Frühauf, F., Fanta, M., Burgetová, A., Fischerová, D. Endometrióza v těhotenství – diagnostika a management. Čes Gynek, 2019, 84(1), s. 61–67.

8. Guerriero, S, Ajossa, S, Mais, V, et al. The diagnosis of endometriomas using colour Doppler energy Imaging. Hum Reprod, 1998, 16(6), p. 1691–1695.

9. Hudelist, G., Fritzer, N., Staettner, S., et al. Uterine sliding sign: a simple sonographic predictor for presence of deep infiltrating endometriosis of the rectum. Ultrasound Obstet Gynecol., 2013 41(6), p. 692–695.

10. Kavoussi, K., Odenwald, KC., Sawsan, A., et al. Incidence of ovarian endometriomas among women with peritoneal endometriosis with and without a history of hormonal contraceptive use. Eur J Obstet Gynec Reprod Biol, 2017, 215, p. 220–223.

11. Levy, G., Dehaene, A., Laurent, N., et al. An update of adenomyosis. Diagnost Interventional Imaging, 2013, 94, p. 3–25.

12. Maheshwari, A., Gurunath, S., Fatima, F., et al. Adenomyosis and subfertility: a systematic review of prevalence, diagnosis,treatment and fertility outcomes. Hum Reprod Update, 2012, 18(4), p. 374–392.

13. Meredith, SM., Sanchez-Ramos, L., Kaunitz, AM. Diagnostic accuracy of transvaginal sonography. Amer J Obstet Gynecol., 2009, 201, p.107.1–107.6.

14. Moore, J., Copley, S., Morris, J., et al. A systematic review of the accuracy of ultrasound in the diagnosis of endometriosis. Ultrasound Obstet Gynecol, 2002, 20, p. 630–634.

15. Nisenblat, V., Bossuyt, PMM., Farquhar, C., et al. Imaging modalities for the non-invasive diagnosis of endometriosis. Cochrane Database of Systematic Reviews, 2016, Issue 2.

16. Patel, MD., Feldstein, VA., Chen, DC., et al. Endometriomas: Diagnostic Performance of US. Radiology, 1999, 210 (3), p. 739–745.

17. Reid, S., Lu, C., Casikar, I., et al. Prediction of pouch of Douglas obliteration in women with suspected endometriosis using a new real-time dynamic transvaginal ultrasound technique: sliding sign. Ultrasound Obstet Gynecol, 2013, 41, p. 685–691.

18. Reinhold, C., Tafazoli, F., Mehio, A., et al. Radiographics [online] 1999, 19, suppl. 1.[cit. 22.3.2019] DOI: https://doi.org/10.1148/radiographics.19.suppl_1.g99oc13s147.

19. Rogers, PA., D‘Hooghe, TM., Fazleabas, A., et al. Priorities for endometriosis research: recommendations from an international consensus workshop. Reprod Sci, 2009,16(4), p. 335–346.

20. Timmerman, D., Arneye, L., Fischerova, D., et al. Simple ultrasound rules to distinguish between benign and malignant adnexal masses before surgery: prospective validation by IOTA group. Brit Med J, 2010, p. 341.

21. Van den Bosch, T., Dueholm, M., Leone, FPG., et al. Terms, definitions and measurements to describe sonographic features of myometrium and uterine masses: a consensus opinion from the Morphological Uterus Sonographic Assessment (MUSA) group. Ultrasound Obstet Gynecol., 2015, 46(3), p. 284–298.

22. Van den Bosch, T., de Bruijn, AM., de Leeuw, RA., et al. A sonographic classification and reporting system for diagnosing adenomyosis. Ultrasound Obstet Gynecol, 2018. Doi 10.1002/uog.19096.

23. Van Holsbeke, C., Van Calster, B., Guerriero, S., et al. Endometriomas: their ultrasound characteristics. Ultrasound Obstet Gynecol, 2010, 35, p. 730–740.

24. Vercellini, P., Somigliana, E., Vigano, P., et al. Blood on the tracks‘ from corpora lutea to endometriomas. Brit J Obstet Gynaecol, 2009, 116(3), p. 366–371.