Journal of the European Society for Gynaecological Endoscopy


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

A. Vigueras Smith 1, R. Cabrera 1, C. Trippia 2, M.Tessman Zomer 1, W. Kondo 1, H.Ferreira 3, L. Carttaxo Da Silva 4, R. Sumak 3

1 Department of Gynaecology, Vita Batel Hospital, Curitiba, Brazil
2 Department of Radiology, Nossa Senhora das Graças Hospital. Curitiba. Brazil
3 Department of Gynaecology, Centro Hospitalar Universitario Do Porto, Universidade do. Minho, Porto Portugal
4 Department of Radiology, Hospital São Luiz Itaim, São Paulo, Brasil


Endometriosis, imaging, ultrasound, diagnosis

Published online: Jan 12 2022


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.