Role of ultrasonography in the diagnosis of endometriosis in infertile women: Ovarian endometrioma, deep endometriosis, and superficial endometriosis

• Published in: Best practice & research. Clinical obstetrics & gynaecology 2024-02, Vol.92, p.102450-102450, Article 102450
• Main Authors: Tan, Samantha, Leonardi, Mathew, Lo, Glen, Lee, Emmeline
• Format: Article
• Language: English
• Subjects: Endometriosis; Imaging; Transvaginal ultrasound
• ISSN: 1521-6934; 1532-1932
• DOI: 10.1016/j.bpobgyn.2023.102450

Endometriosis is a complex chronic inflammatory process characterised by the presence of endometrial-like glandular tissue outside the uterine cavity, typically within the pelvic structures. This condition affects up to 10–15 % of women and those assigned female at birth, and can result in chronic pelvic pain and in/subfertility. Treatment goals include medical, surgical options and alternative therapies. Transvaginal ultrasound (TVUS) is the currently recommended first line investigation for endometriosis with magnetic resonance imaging (MRI) reserved for those with equivocal ultrasound findings. In this paper, we aim to outline the commonly seen sonographic appearances of endometriosis divided into anterior, middle and posterior pelvic compartments. Limitations to ultrasound imaging include high operator dependence and patient factors. New imaging techniques and research into the utility of artificial intelligence (AI) into the detection of endometriosis is currently underway, with possibility of reduced diagnostic delay and better patient outcomes. •Endometriosis is a chronic inflammatory disorder affecting up to 10–15 % women and can cause chronic pain and infertility.•Multiple societies have recommended imaging (transvaginal ultrasoundand magnetic resonance imaging) as the first line investigation.•TVUS remains the first line modality due to relatively low cost, easy access and dynamic imaging.•A standardised ultrasound protocol is recommended to ensure consistency and increase disease detection.•Sonographic appearances of endometriosis has been detailed according to anterior, middle and posterior pelvic compartments.