USING ULTRASOUND FOR THE DIAGNOSIS OF ENDOMETRIOSIS

USING ULTRASOUND FOR THE DIAGNOSIS OF ENDOMETRIOSIS

Advanced Women's Imaging is now providing targeted ultrasounds for the diagnosis of deeply infiltrating endometriosis.
What is endometriosis?
It is the presence of endometrial tissue outside the uterus. It is found most commonly on the ovaries and the pelvic peritoneum.
What is deeply infiltrating endometriosis (DIE)?
Endometriosis can also deeply infiltrate the bowel (especially the recto-sigmoid colon), uterosacral ligaments, bladder and vagina, causing implants, nodules and fibrosis.
Why is DIE important?
The diagnosis of endometriosis is often delayed, with many women suffering symptoms for years before an accurate diagnosis is made. Symptoms of DIE vary widely. A woman with DIE may be asymptomatic, or she may have symptoms including severe dysmenorrhoea and dyschezia.
DIE can be a complex condition to manage, especially if surgical intervention is necessary, being one of the most complicated surgical problems that a gynaecologist deals with.
Does physical examination help in the diagnosis of DIE?
Physical examination of the pelvis is limited in its ability to diagnose DIE and assess its severity.
How can ultrasound help in the diagnosis of DIE?
Targeted transvaginal ultrasound can now be used for the preoperative diagnosis of infiltrative disease with good rates of sensitivity and specificity.
Preoperative diagnosis of DIE helps optimise management for an individual patient. Some patients may respond with hormonal treatment; other patients may need surgical excision of endometriosis. If surgery is needed, the gynaecologist will need to consider the type of surgery, the need for bowel preparation, adequate consent of patients that may require resection of bowel nodules, and planning for the intra-operative assistance of other specialists such as colorectal surgeons.
What does a targeted DIE ultrasound involve?
A targeted DIE ultrasound is more detailed than a routine pelvic ultrasound of the uterus and ovaries. A routine pelvic ultrasound is performed first, then we specifically target areas affected by DIE. This involves assessing the peritoneum of the uterovesical pouch and the pouch of Douglas, the bowel (rectum, sigmoid colon up to 30cm from the anal verge, and free loops of bowel within the pelvis), the uterosacral ligaments, bladder, posterior vaginal fornix, and the rectovaginal septum.
The ultrasound is looking for endometriotic nodules, fibrosis and adhesions involving these structures and the surrounding tissues. This is best assessed in real time, with the ultrasound transducer gently moved back and forth, to see if structures move normally over each other.
How do patients prepare for a targeted DIE ultrasound?
Bowel preparation is not essential to the ultrasound diagnosis of DIE, but it may help in our assessment. This involves a mild laxative such as dulcolax (solution or tablet) taken orally the night before the ultrasound, in addition to a simple rectal enema (133 ml Fleet enema) approximately 1 hour prior to the ultrasound. Bowel preparation will eliminate faeces and bowel gas from the recto-sigmoid immediately prior the scan. These medications are available at minimal cost without prescription at any pharmacy.
What information will a targeted DIE ultrasound provide?
  •  Routine information about the uterus and ovaries, including uterine size, endometrial thickness, ovarian size and follicle number.
  • The presence, size and location of endometriomas.
  • The presence, size, location and depth of bowel lesions, especially recto-sigmoid. This will include an approximate distance of the lowest lesion from the anus, as lesions close to the anus will be more difficult to resect.
  • The presence, size and location of lesions affecting the uterosacral ligaments, bladder, distal ureters, posterior vaginal fornix, and the rectovaginal septum.
  •  The presence and location of adhesions within the pelvis.

Comments

Post a Comment

Popular posts from this blog

WHAT WILL I SEE ON MY PELVIC ULTRASOUND?

WHAT WILL I SEE ON MY PELVIC ULTRASOUND? The pelvic ultrasound will usually examine a number of anatomic structures: The uterus.  Common disorders affecting the uterus include uterine fibroids (benign muscular growths) and adenomyosis (benign infiltration of the endometrium into the surrounding uterine muscle). Both these conditions are commonly associated with heavy and/or painful periods. The endometrium (the lining of the uterus).  The endometrium changes appearance throughout the menstrual cycle. It is usually thin just after the periods have finished and before ovulation (the proliferative phase). The endometrium becomes progressively thicker and whiter on ultrasound as the menstrual cycle progresses after ovulation (the secretory phase). The endometrial thickness is measured and the appearances of the endometrium are noted. A common disorder causing abnormal vaginal bleeding is an endometrial polyp (a growth of the endometrium). Sometimes a saline sonohysterogram may be s
Read more

WILL I HAVE 3D/4D IMAGES DURING MY PELVIC ULTRASOUND?

WILL I HAVE 3D/4D IMAGES DURING MY PELVIC ULTRASOUND? There is a diagnostic role for 3D/4D ultrasound in pelvic scans, although the conventional 2D ultrasound still provides most of the information for the doctor. A conventional 2D ultrasound of the pelvis will always be performed initially, with 3D/4D images added as needed. At Advanced Women’s Imaging, our ultrasound probes are capable of performing both the conventional 2D ultrasound as well as 3D/4D ultrasound. You do not need a separate ultrasound to obtain 3D/4D images if these are required. 3D/4D ultrasound can obtain views of the pelvis that are not seen on the conventional 2D ultrasound, especially views of the uterus. 2D ultrasound can obtain longitudinal and transverse views of the uterus. 3D ultrasound adds in the coronal view (or C-plane) of the uterus, enabling us to get an image of the uterus that is “front on”. 3D/4D ultrasound may help in the diagnosis and assessment of pelvic conditions, including: Congenit
Read more

HOW IS A PELVIC ULTRASOUND PERFORMED?

HOW IS A PELVIC ULTRASOUND PERFORMED? Most pelvic ultrasounds are performed using both the transabdominal and transvaginal approaches. Transabdominal ultrasound  involves scanning through your lower abdomen. Transabdominal ultrasound usually provides an overview of the pelvis rather than detailed images. The transabdominal assessment is particularly helpful for the examination of large pelvic masses extending into the abdomen, which are not always well viewed with transvaginal ultrasound. A small amount of ultrasound gel is put on the skin of the lower abdomen, with the ultrasound probe then scanning through this gel. The gel helps improve contact between the probe and your skin. Transvaginal ultrasound  is an internal ultrasound. It involves scanning with the ultrasound probe lying in the vagina. Transvaginal ultrasound usually produces better and clearer images of the female pelvic organs, because the ultrasound probe lies closer to these structures. The transvaginal ultra
Read more