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  • Print publication year: 2010
  • Online publication date: September 2011

Chapter 15 - Ultrasonography of pelvic endometriosis

from Section 2: - Ultrasonography in infertility


Power Doppler ultrasound (US), in combination with three-dimensional US and virtual organ computer-aided analysis (VOCAL), is a very good approach for investigating the global ovarian vascular network and its correlation with ovarian response in assisted reproductive technology (ART). An ovarian vascular map is easily obtained from a sagittal section of the ovary. Three-dimensional US has become a key tool for diagnosing uterine malformations. Leiomyomas and endometrial polyps are the most frequent benign uterine pathologies, and both can interfere with the reproductive process. The human endometrium undergoes intense angiogenesis during menstrual cycle, and angiogenesis is a key process for successful embryo implantation and development. In reproductive medicine, it is crucial to exclude ectopic pregnancy as early as possible. 3D US is a more accurate technique for evaluating the relationship between the gestational sac and uterine septum and for differentiating between a cornual pregnancy and a displaced intracavitary pregnancy.


1. BarbieriRL. Etiology and epidemiology of endometriosis. Am J Obstet Gynecol 1990; 162: 565–7.
2. NargundG. Ovarian pathology. In: NargundG, ed. Avanced Ultrasound in Reproductive Medicine: A Theoretical and Practical Workshop. London; HER Trust, 2006; 10–14.
3. Revised American Society for Reproductive Medicine Classification of Endometriosis: 1996. Fertil Steril 1997; 67: 817–21.
4. OliveDL, PrittsEA. Treatment of endometriosis. N Engl J Med 2001; 345: 266–75.
5. BrosensI, PuttemansP, CampoR, GordtsS, KinkelK. Diagnosis of endometriosis: pelvis endoscopy and imaging techniques. Best Pract Res Clin Obstet Gynaecol 2004; 18: 285–303.
6. BazotM, DaraiE, HouraniR, et al. Deep pelvis endometriosis: MR imaging for diagnosis and prediction of extension of disease. Radiology 2004; 232: 379–89.
7. ValentinL. Imaging in gynecology. Best Pract Res Clin Obstet Gynaecol 2006; 20: 881–906.
8. KurjakA, KupesicS. Scoring system for prediction of ovarian endometriosis based on transvaginal color and pulsed Doppler sonography. Fertil Steril 1994; 62: 81–8.
9. AlcázarJL, LaparteC, JuradoM, López-GarcíaG. The role of transvaginal ultrasonography combined with color velocity imaging and pulsed Doppler in diagnosis of endometrioma. Fertil Steril 1997; 67: 487–91.
10. GuerrieroS, AjossaS, MaisV, RisalvatoA, LaiMP, MelisGB. The diagnosis of endometriomas using colour Doppler energy imaging. Hum Reprod 1998; 13: 1691–5.
11. WuTT, CoakleyFV, QayyumA, YehBM, JoeBN, ChenLM. Magnetic resonance imaging of ovarian cancer arising in endometriomas. J Comput Assist Tomogr 2004; 28: 836–8.
12. BazotM, BornierC, DubernardG, RoseauG, CortezA, DaraiE. Accuracy of magnetic resonance imaging and rectal endoscopic sonography for the prediction of location of deep pelvic endometriosis. Hum Reprod 2007; 22: 1457–63.
13. Raine-FenningN. Three-dimensional ultrasonographic characteristics of endometrioma. Ultrasound Obstet Gynecol 2008: 31: 718–24.
14. HornsteinMD, HarlowBL, ThomasPP, CheckJH. Use of a new CA 125 assay in the diagnosis of endometriosis. Hum Reprod 1995; 10: 932–4.
15. MolBW, BayramN, LijmerJG, et al. The performance of CA-125 measurement in the detection of endometriosis: a meta-analysis. Fertil Steril 1998; 70: 1101–8.
16. ShwayerJM. Pelvic pain, adnexal masses, and ultrasound. Sem Reprod Med 2008; 26: 252–65.
17. PatelM, FeldsteinV, ChenD, LipsonS, FillyR. Endometriomas: diagnostic performance of US radiology 1999; 3: 739–45.
18. BazotM, ThomassinI, HouraniR, CortezA, DaraiE. Diagnostic accuracy of transvaginal sonography for deep pelvic endometriosis. Ultrasound Obstet Gynecol 2004; 24: 180–5.
19. MenadaMV, RemorgidaV, AbbamonteLH, FulcheriE, RagniN, FerreroS. Transvaginal ultrasonography combined with water-contrast in the rectum in the diagnosis of rectovaginal endometriosis infiltrating the bowel, Fertil Steril 2008; 89: 699–700.
20. DueholmM. Transvaginal ultrasound for diagnosis of adenomyosis: a review. Best Pract Res Clin Obstet Gynaecol 2006; 20: 569–82.
21. ReinholdC, McCarthyS, BretPM, et al. Diffuse adenomyosis: comparison of endovaginal US and MR imaging with histopathologic correlation. Radiology 1996; 199: 151–8.
22. BazotM, CortezA, DaraiE, et al. Ultrasonography compared with magnetic resonance imaging for diagnosis of adenomyosis. Hum Reprod 2001; 16: 2427–33.
23. DueholmM, LundorfE, HansenES, SørensenJS, LedertougS, OlesenF. Magnetic resonance imaging and transvaginal ultrasonography for the diagnosis of adenomyosis. Fertil Steril 2001; 76:588–94.
24. ReinholdC, AtriH, MehioA, AkarianR, IldisA, BretP. Difusse uterine adenomiosis: morphologic criteria and diagnostic accuracy of endovaginal sonography. Radiology 1995; 197: 609–14.
25. Al-AzemiM, BernalAL, SteeleJ, GramsbergenI, BarlowD, KennedyS. Ovarian response to repeated controlled stimulation in in-vitro fertilization cycles in patients with ovarian endometriosis. Hum Reprod 2000; 15: 72–5.
26. Garcia-VelascoJA, SomiglianaE. Management of endometriomas in women requiring IVF: to touch or not to touch. Hum Reprod 2009; 24(3): 496–501.