Which is the best diagnostic method for endometriosis?

Transvaginal ultrasound provides more accurate localisation of vaginal and retovaginal endometriosis compared to magnetic resonance imaging (MRI), according to a study published in the International Journal of Gynecology & Obstetrics. However, MRI is more accurate in detecting bladder endometriosis and should be strongly recommended to patients if bladder endometriosis is suspected, the authors said.

A transvaginal ultrasound is a device used to examine the vagina, uterus, fallopian tubes, ovaries and bladder, which is inserted into the vagina. The device generates sound waves that echo from the pelvic organs and form an image on your computer screen. MRI is a less invasive method that uses a magnetic field and radio waves to produce a detailed image of the pelvic organs.

The accuracy of the two methods does not seem to be affected by the size of the endometriosis nodules. Choosing the right method can increase the accuracy of diagnosing deep infiltrating endometriosis (DIE) and ensure the best treatment is started in time.

In order to compare the effectiveness of the two techniques in detecting DIE and to assess whether the size of the nodules affects diagnostic accuracy, a comprehensive study was carried out under the direction of Dr Roberto Rodriguez at the University Hospital "La Paz" in Madrid.

The study looked at 48 women who had been previously diagnosed with DIE. It was found that transvaginal ultrasound could detect retovaginal endometriosis in 77% of cases, compared to MRI, which was only able to do so in 69%. 

The rate for detection of endometriosis in the vagina on transvaginal ultrasound was 94% compared with 89% on MRI. In contrast, MRI showed a higher accuracy in detecting bladder endometriosis than transvaginal ultrasound (96% vs 92%).

The size of the knots did not affect the accuracy of either technique.

"All parts of the pelvis can be accurately imaged using two complementary and mutually supportive methods for diagnosing DIE," the researchers wrote. They added that MRI should definitely be recommended if bladder involvement is suspected.

Both vaginal ultrasound and MRI can help to diagnose endometriosis, but as histology is also required for a 100% diagnosis, surgery remains the most reliable diagnostic tool for endometriosis. method. 

Source: https://www.ncbi.nlm.nih.gov/pubmed/31220340

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