Transvaginal Ultrasonography Is Superior to MRI for Diagnosing Deep Endometriosis

Transvaginal ultrasonography (TVS) scanning is superior to magnetic resonance imaging (MRI) for diagnosing deep endometriosis recurrence, according to the results of a recent study presented at this year’s Annual Society of Reproductive Medicine meeting.

“Transvaginal ultrasonography and magnetic resonance imaging have similar performance in diagnosing deep endometriosis. The diagnosis of [deep endometriosis] recurrence may be more challenging because of the presence of postoperative fibrosis and adhesions (such as those causing obliteration of the pouch of Douglas),” the researchers wrote.

As part of this prospective study, data from 164 women who underwent a second surgery after surgical excision of deep endometriosis were examined. All participants received a TVS scan, followed by an MRI within 2 months, as well as a laparoscopy conducted within 4 months of MRI. All participants had their deep endometriosis lesions excised.

Of the total patients, 103 had a histological diagnosis of deep endometriosis after the second surgery, 69 had underwent a hysterectomy, 41 had ovarian endometriomas removed, 23 had unilateral adnexectomies, and 8 had bilateral adnexectomies. Some of the participants had undergone more than one surgical procedure.

TVS and MRI were evaluated on a number of factors: accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), and negative likelihood ratio (LR-).

TVS was had an 88.4% accuracy rate, 86.4% sensitivity rate, and 97.8% specificity rate, whereas MRI had a 80.5% accuracy rate, 83.5% sensitivity rate, and 75.4% specificity rate.

TVS had a 94.7% PPV, and MRI had an 85.2% PPV. For NPV, TVS was 80.0% and MRI was 73.0%. Moreover, TVS showed an LR+ value of 10.54 and MRI showed an LR+ value of 3.40; TVS had an LR- value of 0.15 and MRI had an LR- value of 0.22.


—Leigh Precopio



Ferrero S, Scala C, Biscaldi E, Barra F. Ultrasonography has better performance than magnetic resonance in diagnosing deep endometriosis recurrence. Talk presented at: The American Society for Reproductive Medicine; October 17-21, 2020; Virtual