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Young SW, Jha P, Chamié L, Rodgers S, Kho RM, Horrow MM, Glanc P, Feldman M, Groszmann Y, Khan Z, Young SL, Poder L, Burnett TL, Hu EM, Egan S, VanBuren W. Society of Radiologists in Ultrasound Consensus on Routine Pelvic US for Endometriosis. Radiology 2024; 311:e232191. [PMID: 38591980 PMCID: PMC11070694 DOI: 10.1148/radiol.232191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/21/2023] [Accepted: 12/22/2023] [Indexed: 04/10/2024]
Abstract
Endometriosis is a prevalent and potentially debilitating condition that mostly affects individuals of reproductive age, and often has a substantial diagnostic delay. US is usually the first-line imaging modality used when patients report chronic pelvic pain or have issues of infertility, both common symptoms of endometriosis. Other than the visualization of an endometrioma, sonologists frequently do not appreciate endometriosis on routine transvaginal US images. Given a substantial body of literature describing techniques to depict endometriosis at US, the Society of Radiologists in Ultrasound convened a multidisciplinary panel of experts to make recommendations aimed at improving the screening process for endometriosis. The panel was composed of experts in the imaging and management of endometriosis, including radiologists, sonographers, gynecologists, reproductive endocrinologists, and minimally invasive gynecologic surgeons. A comprehensive literature review combined with a modified Delphi technique achieved a consensus. This statement defines the targeted screening population, describes techniques for augmenting pelvic US, establishes direct and indirect observations for endometriosis at US, creates an observational grading and reporting system, and makes recommendations for additional imaging and patient management. The panel recommends transvaginal US of the posterior compartment, observation of the relative positioning of the uterus and ovaries, and the uterine sliding sign maneuver to improve the detection of endometriosis. These additional techniques can be performed in 5 minutes or less and could ultimately decrease the delay of an endometriosis diagnosis in at-risk patients.
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Affiliation(s)
| | | | - Luciana Chamié
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Shuchi Rodgers
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Rosanne M. Kho
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Mindy M. Horrow
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Phyllis Glanc
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Myra Feldman
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Yvette Groszmann
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Zaraq Khan
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Steven L. Young
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Liina Poder
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Tatnai L. Burnett
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Eric M. Hu
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Susan Egan
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Wendaline VanBuren
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
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