By Richard Dargan
Endometriosis occurs when tissue similar to the lining of the uterus grows outside of the uterus. It can cause debilitating pain, heavy menstrual bleeding and infertility. Partly because the symptoms mirror those of other conditions, diagnosis is often delayed significantly. While MRI or surgery is considered the gold standard for diagnosis, US offers a safe, effective imaging tool for initial diagnosis.
Earlier this year, the Society of Radiologists in Ultrasound (SRU) released a consensus statement on routine pelvic US for endometriosis. The consensus established the clinical criteria for performing augmented pelvic US (APU), a technique that involves additional maneuvers to check for endometriosis lesions. Clinical criteria consist mainly of symptoms associated with endometriosis.
Researchers led by Martina Z. Francisco, MD, a radiologist at Stanford University, evaluated the consensus statement in patients who had undergone routine transvaginal US (TVUS) for any reason. They implemented the SRU consensus classification for the interpretation of US, with APU-1 representing normal, APU-2 indicating equivocal for endometriosis and APU-3 being positive for endometriosis.
One-third of the 561 patients in the study met the clinical criteria, and 34% of those were found to have equivocal or positive US findings of endometriosis. Over the five-year follow-up, a significant proportion of patients were confirmed to have endometriosis.
“Two-thirds of the APU-3 patients ended up having an endometriosis diagnosis made by MR imaging or surgery during the follow-up,” Dr. Francisco said. “This validates the SRU consensus and the APU score system as good tools to use as an initial endometriosis diagnosis and as a triage for the diagnosis of endometriosis.”
Early diagnosis through TVUS and APU would be an enormous benefit to patients, as endometriosis can cause severe morbidity leading to pain, surgeries, missed work and a wide range of clinical problems. Currently, delays in diagnosis average seven years.
“Seven years is a long time to live with these symptoms,” Dr. Francisco said. “Patients shouldn’t have to go through all this time without a diagnosis because there are medical and surgical treatments available to relieve the symptoms and the suffering.”
The researchers are developing multi-center imaging studies while they evaluate the data to learn more about what happens in patients whose US findings are equivocal for endometriosis. They also are working to determine if US can preclude the need for MRI.
“Access to MRI is challenging and the protocols need to be well adapted to find endometriosis,” said study co-author Priyanka Jha, MD, associate professor of radiology at Stanford University in CA, and keynote speaker at the session. “Thankfully we don’t have those challenges with ultrasound. The protocol is relatively straightforward and once the awareness gap can be closed, the diagnosis could be made accessible to many across the globe.”
Access the presentation, “Evaluation of Routine Transvaginal Ultrasound for Detecting Endometriosis: Retrospective Cohort Study Based on SRU Consensus Classification,” (W6-SSOB03-4) on demand at RSNA.org/MeetingCentral.
© 2024 RSNA.
The RSNA 2024 Daily Bulletin is the official publication of the 110th Scientific Assembly and Annual Meeting of the Radiological Society of North America. Published online Sunday, December 1 — Friday, December 6.
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