Derin Endometrioziste Ultrasonografik İnceleme
Synopsis
Derin infiltratif endometriozis (DIE), endometriozis hastalığının en ciddi formlarından biridir ve karın içi dokulara, özellikle de rektovajinal septum, bağırsaklar, mesane ve pelvik sinirlere derinlemesine nüfuz eder. Bu hastalığın tanısı ve yönetimi, hasta açısından önemli zorluklar yaratır, çünkü belirtileri hem şiddetli hem de hayat kalitesini düşürücü nitelikte olabilir. DIE'nin doğru bir şekilde tanımlanması, uygun tedavi planının oluşturulması ve cerrahi müdahale gerektiren vakaların belirlenmesi için kritik öneme sahiptir. Bu noktada, ultrasonografi, invaziv olmayan bir yöntem olarak, DIE tanısında önemli bir rol oynar.
Bu bölümde, DIE tanısında ultrasonografinin yeri, kullanım alanları, tanısal doğruluğu ve diğer görüntüleme yöntemleriyle karşılaştırılması ele alınacaktır. Ultrasonografinin sağladığı yüksek çözünürlüklü görüntüler, lezyonların yerleşimi, boyutu ve derinliği hakkında detaylı bilgi sunarak, klinisyenlere hastalığın yaygınlığını ve ciddiyetini değerlendirmede büyük fayda sağlar. Ayrıca, ultrasonografinin, DIE lezyonlarının belirlenmesindeki üstünlüğü, cerrahi planlama ve hastaların tedavi süreçlerini yönlendirmede de kritik bir rol oynar.
Deep infiltrating endometriosis (DIE) is one of the most severe forms of endometriosis, characterized by deep penetration into abdominal tissues, particularly the rectovaginal septum, intestines, bladder, and pelvic nerves. The diagnosis and management of this condition present significant challenges for patients, as symptoms can be both severe and significantly detrimental to quality of life. Accurate identification of DIE is crucial for developing appropriate treatment plans and identifying cases that require surgical intervention. In this context, ultrasonography plays a critical role in the diagnosis of DIE as a non-invasive method.
This section will explore the role of ultrasonography in the diagnosis of DIE, its applications, diagnostic accuracy, and comparison with other imaging modalities. The high-resolution images provided by ultrasonography offer detailed information on the location, size, and depth of lesions, greatly aiding clinicians in assessing the extent and severity of the disease. Furthermore, the superiority of ultrasonography in identifying DIE lesions also plays a critical role in surgical planning and guiding the treatment processes for patients.
References
Haverland R, Young S, Wasson M. Deep Infiltrating Endometriosis: Using Preoperative Radiology for Surgical Planning. J Minim Invasive Gynecol. 2020;27:557-8. DOI: 10.1016/j.jmig.2019.07.014
Parasar P, Ozcan P, Terry KL. Endometriosis: Epidemiology, Diagnosis and Clinical Management. Curr Obstet Gynecol Rep. 2017;6(1):34‐41. DOI: 10.1007/s13669-017-0187-1
Fang, J., and Piessens, S. A step-by-step guide to sonographic evaluation of deep infiltrating endometriosis. Sonography. 2018; 5: 67– 75. https://doi.org/10.1002/sono.12149
Exacoustos C, Manganaro L, Zupi E. Imaging for the evaluation of endometriosis and adenomyosis. Best Pract Res Clin Obstet Gynaecol. 2014;28:655-81. DOI: 10.1016/j.bpobgyn.2014.04.010
Coutinho A, Bittencourt LK, Pires CE, et al. MR imaging in deep pelvic endometriosis: a pictorial essay. Radiographics. 2011; 31:549-567. DOI: 10.1148/rg.312105144
Hindman N, VanBuren W. Imaging Spectrum of Endometriosis (Endometriomas to Deep Infiltrative Endometriosis). Radiol Clin North Am. 2020;58:275-89. DOI: 10.1016/j.rcl.2019.11.001
American Institute of Ultrasound in Medicine (AIUM), American College of Radiology (ACR), American College of Obstetricians and Gynecologists (ACOG), Society for Pediatric Radiology (SPR), So- ciety of Radiologists in Ultrasound (SRU). AIUM practice guideline for the performance of ultrasound of the female pelvis. J Ultrasound Med 2014;33(6): 1122–30.
Benacerraf BR, Groszmann Y. Sonography should be the first imaging examination done to evaluate patients with suspected endometriosis. J Ultrasound Med 2012;31(4):651–3. DOI: 10.7863/jum.2012.31.4.651
Deslandes A, Parange N, Childs JT et al. Current Status of Transvaginal Ultrasound Accuracy in the Diagnosis of Deep Infiltrating Endometriosis Before Surgery. J Ultrasound Med. 2020;9999:1-14. DOI: 10.1002/jum.15246
Goncalves MO, Podgaec S, Dias JA et al. Transvaginal ultrasonography with bowel preparation is able to predict the number of lesions and rectosigmoid layers affected in cases of deep endometriosis, defining surgical strategy. Hum Reprod. 2010;25:665-71. DOI: 10.1093/humrep/dep433
Chamie LP, Pereira RM, Zanatta A, et al. Transvaginal US after bowel preparation for deeply infiltrating endometriosis: protocol, imaging appearances, and laparoscopic correlation. Radiographics 2010;30(5): 1235–49. DOI: 10.1148/rg.305095221
RCOG Green-top Guideline No: 24. 2006. Investigation and management of endometriosis.
NICE guideline 2017. Endometriosis: diagnosis and management.
Working group of ESGE, ESHRE, and WES, Keckstein J, Becker CM et al. Recommendations for the surgical treatment of endometriosis. Part 2: deep endometriosis. Hum Reprod Open. 2020;1:hoaa002. DOI: 10.1093/hropen/hoaa002
Bergamini V, Ghezzi F, Scarperi S, Raffaelli R, Cromi A, Franchi M. Preoperative assessment of intestinal endometriosis: A comparison of transvaginal sonography with water-contrast in the rectum, transrectal sonography, and barium enema. Abdom Imaging 2010; 35: 732–736. DOI: 10.1007/s00261-010-9610-z
Reid S, Winder S, Condous G. Sonovaginography: redefining the concept of a “normal pelvis” on transvaginal ultrasound pre-laparoscopic intervention for suspected endometriosis. Aust J Ultrasound Med 2011; 14: 21–24. doi: 10.1002/j.2205-0140.2011.tb00190.x
Saccardi C, Cosmi E, Borghero A, Tregnaghi A, Dessole S, Litta P. Comparison between transvaginal sonography, saline contrast sonovaginography and magnetic resonance imaging in the diagnosis of posterior deep infiltrating endometriosis. Ultrasound Obstet Gynecol 2012; 40: 464–469. DOI: 10.1002/uog.11102
Leon M, Vaccaro H, Alcazar JL, Martinez J, Gutierrez J, Amor F, Iturra A, Sovino H. Extended transvaginal sonography in deep infiltrating endometriosis: use of bowel preparation and an acoustic window with intravaginal gel: preliminary results. J Ultrasound Med 2014; 33: 315–321. DOI: 10.7863/ultra.33.2.315
Reid S, Lu C, Hardy N, Casikar I, Reid G, Cario G, Chou D, Almashat D, Condous G. Office gel sonovaginography for the prediction of posterior deep infiltrating endometriosis: a multicenter prospective observational study. Ultrasound Obstet Gynecol 2014; 44: 710–718. DOI: 10.1002/uog.13422
Hudelist G, English J, Thomas AE, Tinelli A, Singer CF, Keckstein J. Diagnostic accuracy of transvaginal ultrasound for non-invasive diagnosis of bowel endometriosis: systematic review and meta-analysis. Ultrasound Obstet Gynecol2011; 37: 257–263. DOI: 10.1002/uog.8858
Chapron C, Pietin-Vialle C, Borghese B, Davy C, Foulot H, Chopin N. Associated ovarian endometrioma is a marker for greater severity of deeply infiltrating endometriosis. Fertil Steril 2009; 92: 453–457. DOI: 10.1016/j.fertnstert.2008.06.003
Ghezzi F, Raio L, Cromi A, Duwe DG, Beretta P, Buttarelli M, Mueller MD. “Kissing ovaries”: a sonographic sign of moderate to severe endometriosis. Fertil Steril 2005; 83: 143–147. doi:10.1016/j.fertnstert.2004.05.094
Ulrich U, Buchweitz O, Greb R et al. Interdisciplinary S2k Guidelines for the Diagnosis and Treatment of Endometriosis. Geburtshilfe Frauenheilkd. 2013;73:890-8. doi: 10.1055/s-0033-1350810
Exacoustos C, Manganaro L, Zupi E. Imaging for the evaluation of endometriosis and adenomyosis. Best Pract Res Clin Obstet Gynaecol. 2014;28:655-81. DOI: 10.1016/j.bpobgyn.2014.04.010
Jones LP, Morgan MA, Chauhan A. The sonographic spectrum of pelvic endometriosis: pearls, pitfalls, and mimics. Ultrasound Q 2019;35(4):355–75. DOI: 10.1097/RUQ.0000000000000436
Patel MD, Feldstein VA, Chen DC, et al. Endometrio- mas: diagnostic performance of US. Radiology 1999;210(3):739–45. DOI: 10.1148/radiology.210.3.r99fe61739
Van Holsbeke C, Zhang J, Van Belle V, et al. Acoustic streaming cannot discriminate reliably between endometriomas and other types of adnexal lesion: a multicenter study of 633 adnexal masses. Ultrasound Obstet Gynecol 2010;35(3): 349–53. https://doi.org/10.1002/uog.7537
