A step-by-step guide to sonographic evaluation of deep infiltrating endometriosis

Abstract

An estimated 5–10% of the general female population is affected by endometriosis, with an even higher prevalence among women with infertility or significant symptoms of endometriosis. Transvaginal ultrasound has been shown to be an accurate and reliable diagnostic tool in detecting ovarian endometrioma and deep infiltrating endometriosis. An accurate ultrasound diagnosis, which describes and documents the location and extent of endometriosis, improves patient care by allowing better preoperative surgical planning. This paper provides practical and illustrated guidance on how to perform a multistep sonographic evaluation of deep infiltrating endometriosis with key reference made to the International Deep Endometriosis Analysis consensus paper published in 2016. A comprehensive sonographic evaluation of endometriosis requires imaging beyond the traditional pelvic ultrasound boundaries. This means extending the assessment into the posterior and anterior pelvic compartments to evaluate structural mobility and look for deep infiltrating endometriotic nodules noting the size, location and distance from the anus if applicable. Sonographers are encouraged to incorporate this multistep endometriosis assessment into their routine pelvic scans. An improvement in sonographic detection of deep infiltrating endometriosis will not only significantly reduce the number of diagnostic laparoscopies, it will guide patient management and enhance patients' quality of life.