Saccardi, Carlo and Cosmi, Erich and Borghero, Angela and Tregnaghi, Alberto and Dessole, Salvatore and Litta, Pietro (2012) Comparison between transvaginal ultrasound, sonovaginography and magnetic resonance imaging in the diagnosis of posterior deep infiltrating endometriosis. Ultrasound in Obstetrics & Ginecology, Vol. 40 (4), p. 464-469. eISSN 1469-0705. Article.
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Objective: to compare clinical evaluation, transvaginal ultrasound, sonovaginography and magnetic resonance imaging in the diagnosis of posterior deep pelvic endometriosis.
Methods: women suspected of having posterior deep pelvic endometriosis on the basis of subjective symptoms and clinical evaluation, underwent clinical evaluation, transvaginal ultrasound, sonovaginography and magnetic resonance imaging. Laparoscopy was performed and specimens were sent to histological examination. Sensitivity, specificity, positive and negative predictive value, as well as positive and negative likelihood ratios was analysed for every diagnostic method.
Results: Fifty-four patients out of 102 women suspected of having posterior DPE underwent laparoscopic surgery. Among these, in 46 (85.2%) cases DPE was confirmed at laparoscopic and histological examination. Sonovaginography correctly identified 43 (93.5%) cases, presenting higher accuracy compared to other procedures. Sonovaginography and even magnetic resonance imaging were more accurate in diagnosing and discriminating the different localizations of endometriotic lesions, with sensibility respectively of 94.7% and 73.1% for vaginal fornix, 88.9% and 66.7% for utero-sacral ligaments, and 80.6% and 83.3% for recto-vaginal septum involvement; Specificity of sonovaginography and MRI was respectively of 97.1% and 94.3% for vaginal fornix, 95.6% and 95.6% for utero-sacral ligaments, and 100% and 77.8% for recto-vaginal septum involvement. In the diagnosis of rectal endometriosis, we found mean values of sensibility, 66.7% for both the two techniques and specificity of 93.8% and 95.8%, for sonovaginography and magnetic resonance imaging, respectively.
Conclusions: transvaginal ultrasound should be used as first-line diagnostic techniques and both sonovaginography and/or magnetic resonance imaging as second-line methods in the diagnosis of deep pelvic endometriosis.
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