Endometriozis Tanısında Görüntüleme
Synopsis
Endometriozis, üreme çağındaki kadınları etkileyen ve sıklıkla pelvik ağrıya ve kısırlığa neden olan yaygın bir jinekolojik hastalıktır. En yaygın türleri yüzeysel peritoneal implantlar, over endometriotik kistleri (endometriomalar) ve derin infiltratif subperitoneal lezyonlardır. Tanı genellikle gecikir ve kadınların %65'ine kadarı başlangıçta yanlış teşhis konur. Görüntüleme yöntemleri, hasta danışmanlığında ve hastalığın klinik yönetiminde önemli bir rol oynar ve dünya çapında uzmanlaşmış merkezlerde tanısal laparoskopinin yerini almıştır. Yeterli cerrahi planlama ve doktorların uygun tedavi seçeneklerini belirlemesine yardımcı olmak için kapsamlı görüntüleme gereklidir. Transvajinal ultrason (TVU) birinci basamak görüntüleme yöntemidir ve özel bir protokol kullanıldığında endometriozisin doğru teşhisini sağlayan yaygın olarak bulunan bir araçtır. TVU, çoklu bağırsak lezyonlarını ve küçük peritoneal implantları incelemek için en iyi görüntüleme yöntemidir. Manyetik rezonans görüntüleme (MRG), endometriozisin pelvik boşluğunu ve ekstrapelvik bölgelerini değerlendirmek için birçok kesitli yöntemdir. Yumurtalık kistlerini ayırt etmek ve üreterleri, pelvik sinirleri, pelvik tabanı ve diyaframı etkileyen endometriozisi araştırmak için tercih edilen yöntemdir. Bu Ayrıntılı İnceleme, endometriozisi araştırmak için TVU ve MRI görüntüleme protokolünü ve bulgularını açıklar.
Endometriosis is a common gynecologic disease that affects women of reproductive age and commonly causes pelvic pain and infertility. The most common types are superficial peritoneal implants, ovarian endometriotic cysts (endometriomas), and deep-infiltrating subperitoneal lesions. Diagnosis is often delayed, and up to 65% of women are initially misdiagnosed. Imaging methods play a pivotal role in patient counselling and clinical management of the disease and have been replacing diagnostic laparoscopy in specialized centres worldwide. Comprehensive imaging mapping is required for adequate surgical planning and to assist fertility doctors in determining the appropriate treatment options. Transvaginal ultrasound (TVU) is the first-line imaging modality and is a widely available tool that enables accurate diagnosis of endometriosis when a dedicated protocol is used. TVU is the best imaging method to investigate multiple bowel lesions and small peritoneal implants. Magnetic resonance imaging (MRI) is an excellent multiplanar method for evaluating endometriosis's pelvic cavity and extrapelvic sites. It is the method of choice to differentiate ovarian cysts and investigate endometriosis affecting the ureters, pelvic nerves, pelvic floor, and diaphragm. This In-Depth Review describes the imaging protocol and findings of TVU and MRI to investigate endometriosis.
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