From the Guidelines
Transvaginal ultrasound is the preferred sonogram method for diagnosing endometriosis and adenomyosis. This is based on the most recent evidence from the Journal of the American College of Radiology, which states that TVUS is known to be an accurate study for the evaluation of ovarian endometriomas 1. The study also mentions that expanded TVUS studies have excellent performance for detection of deep infiltrating endometriosis and have shown similar diagnostic performance to pelvic MRI 1.
Key Points to Consider
- Transvaginal ultrasound provides superior visualization of the uterus and surrounding pelvic structures due to the closer proximity of the ultrasound probe to these organs.
- For endometriosis, transvaginal ultrasound can detect ovarian endometriomas and deep infiltrating endometriosis, though it may miss superficial peritoneal lesions.
- For adenomyosis, transvaginal ultrasound can identify characteristic findings such as heterogeneous myometrium, myometrial cysts, and an asymmetrically thickened uterine wall.
- The American College of Radiology recommends US pelvis transvaginal as an equivalent alternative to other imaging procedures for the initial imaging of clinically suspected pelvic endometriosis in an adult patient 1.
Procedure Details
- The procedure typically takes 15-30 minutes and is performed with the patient lying on their back with knees bent.
- A lubricated probe is gently inserted into the vagina, causing minimal discomfort.
- Patients should arrive with a moderately full bladder for the initial transabdominal portion (if performed), which can then be emptied before the transvaginal component.
- This imaging approach is valuable because it's non-invasive, doesn't use radiation, and provides real-time images that help guide treatment decisions.
From the Research
Diagnosis of Endometriosis and Adenomyosis using Sonogram (Ultrasound)
- The sonogram (ultrasound) used for diagnosing endometriosis and adenomyosis is typically transvaginal, as stated in studies 2, 3, 4, 5, 6.
- Transvaginal ultrasound (TVUS) is considered the first line of diagnosis for endometriosis, especially for deep pelvic endometriosis 2.
- TVUS is also effective in diagnosing adenomyosis, but it requires considerable training to recognize the distinct ultrasound pattern 4, 6.
- Transabdominal ultrasound is not typically used for diagnosing endometriosis or adenomyosis, as it has limited field-of-view and low accuracy in detecting upper bowel lesions 5.
Comparison with other Diagnostic Modalities
- Magnetic Resonance Imaging (MRI) is also used to diagnose endometriosis and adenomyosis, and its diagnostic accuracy is similar to that of TVUS 2, 4, 5.
- MRI is particularly useful in diagnosing lesions located above the rectosigmoid junction and in detecting ureteric endometriosis 3, 5.
- TVUS and MRI are complementary diagnostic modalities, and the choice of modality depends on the specific clinical scenario and the availability of expertise 2, 4, 5.