Importance of Transvaginal Ultrasound Applying Elastography for Identifying Deep Infiltrating Endometriosis – A Feasibility Study

Abstract

Purpose: To evaluate the presence of a lesion indicative of endometriosis with transvaginal elastography.

Materials and Methods: Transvaginal ultrasound and clinical examination were carried out in 48 women with clinical symptoms indicative of endometriosis. In 31 cases strain values were measured at two regions of interest (ROIs) in the Douglas's cul-de-sac during a cycle of compression and decompression with a vaginal probe.

Results: A significant difference was found for the ratio of the ROI measuring points in the Douglas' cul-de-sacs of women with a palpable nodule in examination compared to women without a palpable nodule (p = 0.002).

Conclusion: The ratio of strain values between two ROIs in the Douglas' s cul-de-sac is associated with the presence of an endometriotic lesion. In the future, these findings could allow for a more detailed pre-surgical evaluation and possibly serve as a novel diagnostic tool for predicting deep infiltrating endometriosis.

Zusammenfassung

Ziel: Beurteilung des Vorliegens eines Endometrioseherdes mithilfe transvaginaler Elastografie.

Material und Methoden: Bei 48 Frauen mit typischer klinischer Symptomatik wurde ein transvaginaler Ultraschall und eine klinische Untersuchung durchgeführt. In 31 Fällen wurde die Verformbarkeit des Gewebes während abwechselnder Kompression und Dekompression gemessen. Diese Messungen fanden an zwei umschriebenen Bereichen des Douglas-Raums, so genannten “Regions of interest” (ROIs), statt.

Ergebnisse: Im Vergleich von Frauen, bei denen in der klinischen Untersuchung ein Knoten getastet wurde, und Frauen, die keinen solchen Knoten aufwiesen, zeigte sich ein signifikanter Unterschied der Ratio der ROI-Messpunkte des Douglas-Raums (p = 0,002).

Schlussfolgerung: Die Ratio der ROI-Messpunkte des Douglas-Raums ist mit dem Vorliegen eines Endometrioseherdes assoziiert. In der zukünftigen Anwendung können diese Erkenntnisse eine zusätzliche präoperative Einschätzung von Endometrioseherdbefunden ermöglichen. Die Elastografie kann als neue Methode in der Diagnostik der tief infiltrierenden Endometriose eingesetzt werden.

Key words

endometriosis - ultrasound - pelvic organs - uterus

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