Skip to main content
SpringerLink
Log in
Book cover

How to Perform Ultrasonography in Endometriosis pp 133–145Cite as

Modified Ultrasonographic Techniques

  • Chapter
  • First Online:

Abstract

Nowadays, transvaginal ultrasonography (TVS) is the first-line investigation in women with suspicion of deep infiltrating endometriosis (DE). However, TVS diagnostic accuracy is dependent on the experience of the sonographers and may be improved by distending the vagina and/or rectum with saline solution or gel. These modified ultrasound techniques may be useful when the findings of TVS are inconclusive or when the sonographers have limited experience in the diagnosis of DE. This chapter will describe the most commonly modified ultrasound techniques used in the diagnosis of DE including tenderness-guided transvaginal ultrasonography (tg-TVS), sonovaginography (SVG), rectal water contrast transvaginal ultrasonography (RWC-TVS), and three-dimensional rectosonography (3D-RSG).

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Piketty M, Chopin N, Dousset B, Millischer-Bellaische AE, Roseau G, Leconte M, et al. Preoperative work-up for patients with deeply infiltrating endometriosis: transvaginal ultrasonography must definitely be the first-line imaging examination. Hum Reprod. 2009;24(3):602–7.

    Article  Google Scholar 

  2. Guerriero S, Condous G, Van den Bosch T, Valentin L, Leone FP, Van Schoubroeck D, et al. Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis, including terms, definitions and measurements: a consensus opinion from the International Deep Endometriosis Analysis (IDEA) group. Ultrasound Obstet Gynecol. 2016;48(3):318–32.

    Article  CAS  Google Scholar 

  3. Guerriero S, Ajossa S, Gerada M, D’Aquila M, Piras B, Melis GB. “Tenderness-guided” transvaginal ultrasonography: a new method for the detection of deep endometriosis in patients with chronic pelvic pain. Fertil Steril. 2007;88(5):1293–7.

    Article  Google Scholar 

  4. Saba L, Guerriero S, Sulcis R, Pilloni M, Ajossa S, Melis G, et al. MRI and “tenderness guided” transvaginal ultrasonography in the diagnosis of recto-sigmoid endometriosis. J Magn Reson Imaging. 2012;35(2):352–60.

    Article  Google Scholar 

  5. Guerriero S, Ajossa S, Gerada M, Virgilio B, Angioni S, Melis GB. Diagnostic value of transvaginal ‘tenderness-guided’ ultrasonography for the prediction of location of deep endometriosis. Hum Reprod. 2008;23(11):2452–7.

    Article  Google Scholar 

  6. Sibal M. Gel sonovaginography: a new way of evaluating a variety of local vaginal and cervical disorders. J Ultrasound Med. 2016;35(12):2699–715.

    Article  Google Scholar 

  7. Dessole S, Farina M, Rubattu G, Cosmi E, Ambrosini G, Nardelli GB. Sonovaginography is a new technique for assessing rectovaginal endometriosis. Fertil Steril. 2003;79(4):1023–7.

    Article  Google Scholar 

  8. Saccardi C, Cosmi E, Borghero A, Tregnaghi A, Dessole S, Litta P. Comparison between transvaginal sonography, saline contrast sonovaginography and magnetic resonance imaging in the diagnosis of posterior deep infiltrating endometriosis. Ultrasound Obstet Gynecol. 2012;40(4):464–9.

    Article  CAS  Google Scholar 

  9. Reid S, Bignardi T, Lu C, Lam A, Condous G. The use of intra-operative saline sonovaginography to define the rectovaginal septum in women with suspected rectovaginal endometriosis: a pilot study. Australas J Ultrasound Med. 2011;14(3):4–9.

    Article  Google Scholar 

  10. Reid S, Winder S, Condous G. Sonovaginography: redefining the concept of a “normal pelvis” on transvaginal ultrasound pre-laparoscopic intervention for suspected endometriosis. Australas J Ultrasound Med. 2011;14(2):21–4.

    Article  Google Scholar 

  11. Reid S, Lu C, Hardy N, Casikar I, Reid G, Cario G, et al. Office gel sonovaginography for the prediction of posterior deep infiltrating endometriosis: a multicenter prospective observational study. Ultrasound Obstet Gynecol. 2014;44(6):710–8.

    Article  CAS  Google Scholar 

  12. Leon M, Vaccaro H, Alcazar JL, Martinez J, Gutierrez J, Amor F, et al. Extended transvaginal sonography in deep infiltrating endometriosis: use of bowel preparation and an acoustic window with intravaginal gel: preliminary results. J Ultrasound Med. 2014;33(2):315–21.

    Article  Google Scholar 

  13. Rubin C, Kurtz AB, Goldberg BB. Water enema: a new ultrasound technique in defining pelvic anatomy. J Clin Ultrasound. 1978;6(1):28–33.

    Article  CAS  Google Scholar 

  14. Valenzano Menada M, Remorgida V, Abbamonte LH, Nicoletti A, Ragni N, Ferrero S. Does transvaginal ultrasonography combined with water-contrast in the rectum aid in the diagnosis of rectovaginal endometriosis infiltrating the bowel? Hum Reprod. 2008;23(5):1069–75.

    Article  CAS  Google Scholar 

  15. Ferrero S, Biscaldi E, Vellone VG, Venturini PL, Leone Roberti Maggiore U. Computed tomographic colonography vs rectal water-contrast transvaginal sonography in diagnosis of rectosigmoid endometriosis: a pilot study. Ultrasound Obstet Gynecol. 2017;49(4):515–23.

    Article  CAS  Google Scholar 

  16. Leone Roberti Maggiore U, Biscaldi E, Vellone VG, Venturini PL, Ferrero S. Magnetic resonance enema vs rectal water-contrast transvaginal sonography in diagnosis of rectosigmoid endometriosis. Ultrasound Obstet Gynecol. 2017;49(4):524–32.

    Article  CAS  Google Scholar 

  17. Bergamini V, Ghezzi F, Scarperi S, Raffaelli R, Cromi A, Franchi M. Preoperative assessment of intestinal endometriosis: a comparison of transvaginal sonography with water-contrast in the rectum, transrectal sonography, and barium enema. Abdom Imaging. 2010;35(6):732–6.

    Article  Google Scholar 

  18. Ferrero S, Biscaldi E, Morotti M, Venturini PL, Remorgida V, Rollandi GA, et al. Multidetector computerized tomography enteroclysis vs. rectal water contrast transvaginal ultrasonography in determining the presence and extent of bowel endometriosis. Ultrasound Obstet Gynecol. 2011;37(5):603–13.

    Article  CAS  Google Scholar 

  19. Menada MV, Remorgida V, Abbamonte LH, Fulcheri E, Ragni N, Ferrero S. Transvaginal ultrasonography combined with water-contrast in the rectum in the diagnosis of rectovaginal endometriosis infiltrating the bowel. Fertil Steril. 2008;89(3):699–700.

    Article  Google Scholar 

  20. Philip CA, Bisch C, Coulon A, de Saint-Hilaire P, Rudigoz RC, Dubernard G. Correlation between three-dimensional rectosonography and magnetic resonance imaging in the diagnosis of rectosigmoid endometriosis: a preliminary study on the first fifty cases. Eur J Obstet Gynecol Reprod Biol. 2015;187:35–40.

    Article  Google Scholar 

  21. Philip CA, Bisch C, Coulon A, Maissiat E, de Saint-Hilaire P, Huissoud C, et al. Three-dimensional sonorectography: a new transvaginal ultrasound technique with intrarectal contrast to assess colorectal endometriosis. Ultrasound Obstet Gynecol. 2015;45(2):233–5.

    Article  CAS  Google Scholar 

  22. Guerriero S, Ajossa S, Minguez JA, Jurado M, Mais V, Melis GB, et al. Accuracy of transvaginal ultrasound for diagnosis of deep endometriosis in uterosacral ligaments, rectovaginal septum, vagina and bladder: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2015;46(5):534–45.

    Article  CAS  Google Scholar 

  23. Guerriero S, Ajossa S, Orozco R, Perniciano M, Jurado M, Melis GB, Alcazar JL. Accuracy of transvaginal ultrasound for diagnosis of deep endometriosis in the rectosigmoid: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2016;47(3):281–9.

    Google Scholar 

  24. Hoyos LR, Johnson S, Puscheck E. Endometriosis and imaging. Clin Obstet Gynecol. 2017;60(3):503–16.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Academic Unit of Obstetrics and Gynecology, Ospedale Policlinico San Martino, Genoa, Italy

    Simone Ferrero, Umberto Leone Roberti Maggiore, Fabio Barra & Carolina Scala

  2. Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy

    Simone Ferrero, Umberto Leone Roberti Maggiore, Fabio Barra & Carolina Scala

Authors
  1. Simone Ferrero
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Umberto Leone Roberti Maggiore
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fabio Barra
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Carolina Scala
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Simone Ferrero .

Editor information

Editors and Affiliations

  1. Department of Obstetrics and Gynecology, University of Cagliari, Cagliari, Italy

    Stefano Guerriero

  2. Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Sydney, Australia

    George Condous

  3. Obstetrics and Gynecology Department, University of Navarra, Pamplona, Spain

    Juan Luis Alcázar

14.1 Electronic Supplementary Material

RWC-TVS shows a mild stenosis (≥50%) of the rectal lumen due to endometriosis. The endometriotic nodule is hypoechoic and has blurred margins. A thinner section (“tail”) is noted at one end. During surgery, nodule shaving was performed (MOV 24888 kb)

RWC-TVS shows a significant intestinal stenosis (≥50%) of the rectal lumen due to endometriosis. The endometriotic nodule, located on the anterior rectum, causes a thickening of the hypoechoic muscularis propria. The nodule is hypoechoic and has blurred margins. A thinner section (“tail”) is noted at one end. The nodule infiltrates the rectal submucosa and mucosa. The patient was treated by segmental resection (Fig. 14.13) (MOV 31786 kb)

Sonovaginography with gel. An assistant holds the bottle of gel with its mouth facing downward. The syringe is introduced into the lower part of the inverted bottle. The plunger is held steady in position, and the barrel (outer sleeve) is slowly pushed farther up into the inverted bottle of gel to fill the syringe with 20 mL of gel [6] (MOV 132000 kb)

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Ferrero, S., Maggiore, U.L.R., Barra, F., Scala, C. (2018). Modified Ultrasonographic Techniques. In: Guerriero, S., Condous, G., Alcázar, J.L. (eds) How to Perform Ultrasonography in Endometriosis. Springer, Cham. https://doi.org/10.1007/978-3-319-71138-6_14

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-71138-6_14

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-71137-9

  • Online ISBN: 978-3-319-71138-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation