What is the role of imaging in the diagnosis and treatment of endometrioma/endometriosis?

Updated: Dec 14, 2018
  • Author: Shawn Daly, MD; Chief Editor: Eugene C Lin, MD  more...
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Answer

Answer

Plain film radiography, computed tomography (CT) scanning, and barium studies are not sensitive for the diagnosis of endometriosis. Moreover, the appearance of implants and endometriomas is nonspecific. US scanning and MRI are not sensitive for superficial lesions. US scanning is not sensitive for the detection of large implants.

The results of a Cochrane Systematic Review of imaging modalities for the noninvasive diagnosis of endometriosis concluded that none of the imaging modalities were able to detect overall pelvic endometriosis with enough accuracy to replace surgery. Specifically for endometrioma, TVUS qualified as a triage test. TVUS could also be used clinically to identify additional anatomic sites of DIE, as compared to MRI, thus facilitating preoperative planning. [5]

(Endovaginal sonogram of endometrioma is shown below.)

Endovaginal ultrasound scan of an endometrioma. No Endovaginal ultrasound scan of an endometrioma. Note the characteristic diffuse, low-level echoes of the endometrioma (E) giving a solid appearance.

MRI of endometrioma is shown in the image below.

T1-weighted magnetic resonance image of an endomet T1-weighted magnetic resonance image of an endometrioma. Note the characteristic high signal intensity (similar to that of fat) of this right-sided adnexal endometrioma (arrow).

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