Journal of Medical Ultrasonics

, Volume 46, Issue 1, pp 123–128 | Cite as

Evaluation of pelvic floor muscle by transperineal elastography in patients with deep infiltrating endometriosis: preliminary observation

  • Meng Xie
  • Yu Feng
  • Xuyin Zhang
  • Keqin Hua
  • Yunyun RenEmail author
  • Wenping WangEmail author
Original Article



To assess the elasticity of the pelvic floor muscle (PFM) affected by deep infiltrating endometriosis (DIE) with transperineal elastography.


This prospective observational study included 88 patients who were diagnosed with DIE, ovarian endometrioid cyst, or ovarian teratoma. All the patients were assigned to one of the three groups and underwent transperineal elastography. The scoring system and strain ratio (SR) values were recorded and analyzed. Assessments were conducted at maximal Valsalva and under quiescent condition, respectively.


The mean elastography score was statistically significantly higher for the levator ani of group I than groups II and III under quiescent condition. In addition, SR of the levator ani in group I was higher than that in groups II and III. However, at maximal Valsalva, the mean elastography score of group I was lower than that of groups II and III. In addition, SR of group I was lower than that of groups II and III.


The elasticity of the PFM in DIE patients could be qualitatively evaluated by transperineal elastography. The coordination of the PFM was injured and decreased elasticity appeared in DIE patients.


Transperineal elastography Deep infiltrating endometriosis Pelvic floor muscle 



This study was supported by a grant from the fund for scientific research of Chinese Preventive Medicine Association (Grant no. 201809031).

Compliance with ethical standards

Conflict of interest

We declare that we have no conflicts of interest.

Ethical approval

The study design and protocol were approved by the Institutional Review Board of the Obstetrics and Gynecology Hospital of Fudan University, Shanghai, P. R. China. In addition, all patients gave written informed consent after the procedure was explained fully.


  1. 1.
    Giudice LC. Clinical practice. Endometriosis. N Engl J Med. 2010;362:2389–98.CrossRefGoogle Scholar
  2. 2.
    Koninckx PR, Meuleman C, Demeyere S, et al. Suggestive evidence that pelvic endometriosis is a progressive disease, whereas deeply infiltrating endometriosis is associated with pelvic pain. Fertil Steril. 1991;55:759–65.CrossRefGoogle Scholar
  3. 3.
    Koninckx PR, Ussia A, Adamyan L, et al. Deep endometriosis: definition, diagnosis, and treatment. Fertil Steril. 2012;98:564–71.CrossRefGoogle Scholar
  4. 4.
    Baker PK. Musculoskeletal origins of chronic pelvic pain—diagnosis and treatment. Obstet Ginecol Clin North Am. 1993;20:719–43.Google Scholar
  5. 5.
    FitzGerald MP, Kotarinos R. Rehabilitation of the short pelvic floor I: background and patient evaluation. Int Urogynecol J. 2003;14:261–8.CrossRefGoogle Scholar
  6. 6.
    Dos Bispo AP, Ploger C, Loureiro AF, et al. Assessment of pelvic floor muscles in women with deep endometriosis. Arch Gynecol Obstet. 2016;294:519–23.CrossRefGoogle Scholar
  7. 7.
    Butrick CW. Pelvic floor hypertonic disorders: identification and management. Obstet Gynecol Clin North Am. 2009;36:707–22.CrossRefGoogle Scholar
  8. 8.
    Raimondo D, Youssef A, Mabrouk M, et al. Pelvic floor muscle dysfunction on D/4D transperineal ultrasound in patients with deepinfiltrating endometriosis: a pilot study. Ultrasound Obstet Gynecol. 2017;50:527–32.CrossRefGoogle Scholar
  9. 9.
    Lyshchik A, Higashi T, Asato R, et al. Thyroid gland tumor diagnosis at US elastography. Radiology. 2005;237:202–11.CrossRefGoogle Scholar
  10. 10.
    Heim LJ. Evaluation and differential diagnosis of dyspareunia. Am Fam Physician. 2001;63:1535–44.Google Scholar
  11. 11.
    Butrick CW. Pathophysiology of pelvic floor hypertonic disorders. Obstet Gynecol Clin North Am. 2009;36:699–705.CrossRefGoogle Scholar
  12. 12.
    Yap EC. Myofascial pain—an overview. Ann Acad Med Singap. 2007;36:43–8.Google Scholar
  13. 13.
    Mabrouk M, Raimondo D, Del Forno S, et al. Pelvic floor muscle assessment at -and 4-dimensional transperineal ultrasound in women with endometriosis, with or without retroperitoneal infiltration: a step towards complete functional assessment. Ultrasound Obstet Gynecol. 2018;52:265–8 (Epub ahead of print).CrossRefGoogle Scholar
  14. 14.
    Xie M, Zhang X, Liu J, et al. Evaluation of levator ani with no defect on elastography in women with POP. Int J Clin Exp Med. 2015;8:10204–12.Google Scholar
  15. 15.
    Xie M, Zhang X, Zhang X, et al. Can we evaluate the levator ani after Kegel exercise in women with pelvic organ prolapse by transperineal elastography? A preliminary study. J Med Ultrasonics. 2018;45:437–41.CrossRefGoogle Scholar

Copyright information

© The Japan Society of Ultrasonics in Medicine 2018

Authors and Affiliations

  1. 1.Department of UltrasoundFudan UniversityShanghaiChina
  2. 2.Department of Gynecology, Obstetrics and Gynecology HospitalFudan UniversityShanghaiChina
  3. 3.Department of Ultrasound, Zhongshan HospitalFudan UniversityShanghaiChina

Personalised recommendations