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To determine the diagnostic accuracy of pelvic magnetic resonance imaging (MRI), transvaginal sonography (TVS), and transrectal sonography (TRS) in diagnosis of deep infiltrating endometriosis (DIE).
This diagnostic accuracy study was conducted during a 2-year period including a total number of 317 patients with signs and symptoms of endometriosis....
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Citations
... They found a pooled sensitivity and specificity of 64% and 98%, respectively. In a review of prospective studies (Gerges et al., 2021c), while pooled analyses could not be performed due to the limited number of studies, two studies were described which assessed 2D-MRI, reporting sensitivities ranging from 50% (Guerriero et al., 2018b) to 100% (Alborzi et al., 2018) and specificities ranging from 97% (Guerriero et al., 2018b) to 100% (Alborzi et al., 2018). MRI with rectal ultrasound gel performed similarly to this, with a sensitivity of 70% and specificity of 100% (Hottat et al., 2009). ...
... They found a pooled sensitivity and specificity of 64% and 98%, respectively. In a review of prospective studies (Gerges et al., 2021c), while pooled analyses could not be performed due to the limited number of studies, two studies were described which assessed 2D-MRI, reporting sensitivities ranging from 50% (Guerriero et al., 2018b) to 100% (Alborzi et al., 2018) and specificities ranging from 97% (Guerriero et al., 2018b) to 100% (Alborzi et al., 2018). MRI with rectal ultrasound gel performed similarly to this, with a sensitivity of 70% and specificity of 100% (Hottat et al., 2009). ...
The International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) and International Deep Endometriosis Analysis (IDEA) group, the European Endometriosis League (EEL), the European Society for Gynaecological Endoscopy (ESGE), the European Society of Human Reproduction and Embryology (ESHRE), the International Society for Gynecologic Endoscopy (ISGE), the American Association of Gynecologic Laparoscopists (AAGL) and the European Society of Urogenital Radiology (ESUR) elected an international, multidisciplinary panel of gynecological surgeons, sonographers and radiologists, including a steering committee, which searched the literature for relevant articles in order to review the literature and provide evidence-based and clinically relevant statements on the use of imaging techniques for non-invasive diagnosis and classification of pelvic deep endometriosis. Preliminary statements were drafted based on a review of the relevant literature. Following two rounds of revisions and voting orchestrated by chairs of the participating societies, consensus statements were finalized. A final version of the document was then resubmitted to the society chairs for approval. Twenty statements were drafted, of which 14 reached strong and three moderate agreement after the first voting round. The remaining three statements were discussed by all members of the steering committee and society chairs and rephrased, followed by an additional round of voting. At the conclusion of the process, 14 statements had strong and five statements moderate agreement, with one statement left in equipoise. This consensus work aims to guide clinicians involved in treating women with suspected endometriosis during patient assessment, counselling and planning of surgical treatment strategies.
... Although it has limited indications in the diagnosis of endometriosis, MRI may be used as a non-invasive diagnostic method for deep infiltrating endometriosis. It has a high accuracy, offering the possibility to fully investigate the pelvic cavity [40]. Moreover, when the transvaginal ultrasound scan is not conclusive, MRI has been proven to be useful for diagnosing endometrioma in the presence of an adnexal mass. ...
Endometriosis is a chronic inflammatory disease, characterized by the presence of ectopic endometrial tissue, that leads to dysmenorrhea, painful intercourse and infertility. The shift in paradigm from the previous belief that endometriosis exclusively impacts women of reproductive age has brought attention to the condition in both premenarchal and postmenopausal women. Currently, 2–4% of postmenopausal women have endometriosis. Many women experience menopausal symptoms during the peri- and postmenopausal periods and require extensive investigations and monitoring in order to avoid the recurrence of endometriosis symptoms or the risk of malignant transformation when treatment with menopausal hormones is elected. Our goal was to compile and present a clear and concise overview of the existing literature on postmenopausal endometriosis, offering an up-to-date and precise summary of the available information.
... This remedy has demonstrated efficacy in managing advanced and metastatic prostate and breast cancers, as well as central precocious puberty. Instead of requiring daily subcutaneous injections, the formulation of controlled-release alternatives has significantly enhanced patient adherence [21][22][23][24]. However, to the best of our knowledge, comprehensive information on the release of triptorelin acetate from PLGA-based ISFIs and the polymer degradation process at various temperatures remains scarce. ...
This study explores the impact of varying temperatures on the release behavior of Triptorelin Acetate (TA) from a PLGA-based in-situ forming implant (ISFI) and polymer degradation. Formulations were prepared using the in situ forming method in an acetate buffer (pH = 6.8) and then exposed to temperatures of 4 to 60 °C. The drug release and polymeric depot behavior were evaluated using HPLC, SEM, GPC, Rheometer, and pH measurements. A modified Gallagher-Corrigan Model-based mathematical model was applied to fit the in-vitro data, and the activation energy for peptide release in diffusional and erosional phases was calculated using the Arrhenius equation. The results revealed that matrices formed at 37, 45, and 53 °C exhibited a highly porous structure, resulting from rapid phase inversion and surface pore closing. This led to a reduction in TA burst release, observed as 38%, 27%, and 15% at 37 °C, 45 °C, and 53 °C respectively. Conversely, matrices at 4 and 25 °C demonstrated a faster initial release, followed by the formation of dense structures. The accelerated drug release profiles at 45 and 53 °C showed a shortened ultimate drug release duration and a good correlation with the real-time results at 37 °C. Due to the discernible PLGA matrices degradation at different temperatures, biphasic and tri-phasic release patterns were observed. The experimental release results aligned well with the proposed mathematical model, and the drug release kinetic parameters were estimated. Thus, in in-vitro studies, the release medium temperature plays a significant role in the drug-release behavior of ISFIs.
Graphical Abstract
... Thus, keeping in mind the dark corners of US and its uneven acceptability, further or alternative investigations are advisable in the case of symptomatic adolescents [8,89] with no clear diagnosis or when a US exam is not applicable nor accepted. In these cases, MRI may be a valuable option [112][113][114]. ...
Endometriosis has a prevalence of 10% worldwide in premenopausal women. Probably, endometriosis begins early in the life of young girls, and it is commonly diagnosed later in life. The prevalence of deep infiltrating endometriosis (DIE) in adolescence is currently unknown due to diagnostic limits and underestimation of clinical symptoms. Dysmenorrhea is a common symptom in adolescents affected by DIE, often accompanied by dyspareunia and chronic acyclic pelvic pain. Ultrasonography—either performed transabdominal, transvaginal or transrectal—should be considered the first-line imaging technique despite the potential for missed diagnosis due to early-stage disease. Magnetic resonance imaging should be preferred in the case of virgo patients or when ultrasonographic exam is not accepted. Diagnostic laparoscopy is deemed acceptable in the case of suspected DIE not responding to conventional hormonal therapy. An early medical and/or surgical treatment may reduce disease progression with an immediate improvement in quality of life and fertility, but at the same time, painful symptoms may persist or even recur due to the surgery itself. The aim of this narrative review is to report the prevalence of DIE in adolescents, describe the pathogenetic theories and discuss the management in adolescent women, including the challenging road to diagnosis and the treatment alternatives.
... TVUZ ima prednost zaradi manjšega obsevanja in je glavna metoda za ocenjevanje adneksalnih tumorjev, vendar je nekoliko omejen za diagnosticiranje drugih oblik endometrioze. Dodatno igra TVUZ vlogo pri ocenjevanju razširjenosti bolezni, ki vključuje mehur in rektum (18,19). Hidronefrozo ali hidroureter vidimo že z UZ preiskavo, lahko tudi na CT preiskavi. ...
Endometrioza je bolezen, ki lahko prizadene 2–5 % vseh žensk v pomenopavznem obdobju. Gre za bolezen, pri kateri se endometrijske žleze in stroma nahajajo zunaj maternice. O pomenopavzni endometriozi je zaenkrat v literaturi še malo znanih podatkov. V sklopu diagnosticiranja je v tem obdobju v ospredju predvsem skrb, da gre morda za maligno bolezen. Poročila v literaturi opisujejo ponovitev endometrioze v pomenopavznem obdobju kot tudi nastanek endometrioze »de novo«. Zdravljenje izbire simptomatske endometrioze v pomenopavzi je kirurško z odstranitvijo vsega vidnega endometriotičnega tkiva zaradi višjega tveganja za ponovitev bolezni in preobrat v maligno bolezen. Hormonsko zdravljenje po menopavzi (MHZ) se pogosto uporablja za lajšanje simptomov in preprečevanje izgube kostne mase. Obstajajo raziskave, ki dokazujejo, da MHZ lahko ponovno aktivira endometriotična žarišča in celo spodbuja maligno preoblikovanje žarišč pri ženskah z anamnezo endometrioze. Glede na ne povsem razjasnjena tveganja MHZ pri tovrstnih bolnicah se svetuje dodatna previdnost.
... Важную роль в инструментальной диагностике инфильтративного эндометриоза играет трансвагинальное ультразвуковое исследование органов малого таза [8]. Трансвагинальное ультразвуковое исследование имеет отличные характеристики: до 89% чувствительность, почти 85% специфичность [9,10]. ...
Introduction. Endometriosis is a chronic estrogen-dependent disease characterized by the presence of endometrial-like tissue outside the uterine cavity and most often manifested by pelvic pain and infertility. It affects up to 10% of women of reproductive age, which is about 190 million women worldwide, and it is a serious medical and social issue. In the clinical context, it is advisable to search for biomarkers of the disease to ensure early noninvasive diagnosis. Current literature on potential biomarkers of endometriosis is already quite extensive. However, despite many publications, there is no consensus on and no similar approaches to defining such markers. Therefore, the search for potential biomarkers of endometriosis is still relevant. Aim: To summarize the information of contemporary literature on possible biomarkers of endometriosis that can be used in its early diagnosis and treatment. Materials and Methods. This is a review of publications based on search results in electronic resources in Russian and international systems, such as eLibrary, PubMed, MedLine, Crossref, etc., over the past 8 years (2015-2023). Results and Discussion. A constantly improving palette of the latest technologies that include and combine metabolomics, genomics, and proteomics, can be the key to success in finding reliable biomarkers. For such a complex and heterogeneous disease as endometriosis, a panel of biomarkers is likely to be more accurate than a single marker, both for the diagnosis and probably for helping classify subtypes of the disease. Conclusion. Current literature on potential biomarkers is quite extensive, but the desired result has not been achieved yet. Further research is needed.
... Specifically, MRI demonstrates a sensitivity range of 63.5% to 95.6%, whereas TVS shows a sensitivity range of 55.6% to 78.3%. The specificity levels of TVS, ranging from 66.7% to 98%, and MRI, ranging from 60% to 93.9%, exhibit similar values [17,[20][21][22][23][24][25]26]. ...
... Based on data extracted from academic literature, it has been reported that MRI exhibits a sensitivity ranging from 76.9% to 94% and a specificity ranging from 50% to 96.6% in the context of diagnosing recto-sigmoid intestinal endometriosis lesions [17,20,22,23,25]. The findings of our study demonstrate a high level of concordance between the MRI diagnosis of rectal nodules and the intraoperative diagnosis. ...
Endometriosis, an intriguing gynecological illness, poses a substantial health concern for women of reproductive age, despite its widespread occurrence and limited comprehension. The objective of this study is to assess the diagnostic precision of transvaginal sonography (TVS) and pelvic magnetic resonance imaging (MRI) for the identification of deep infiltrated endometriosis (DIE). This study encompassed a cohort of 256 patients exhibiting signs and symptoms of endome-triosis, with the aim of assessing the diagnostic accuracy over a span of four years. Both TVS and pelvic MRI were employed in the same centers to analyze each subject. The histopathologic analysis and laparoscopy were the most reliable and widely accepted methods for evaluation. TVS is a reliable diagnostic tool for ovarian endometriomas, obviating the necessity for MRI confirmation. The specificity of TVS in diagnosing ovarian endometriomas is 57.14%, while its sensitivity is 93.78%, resulting in an overall accuracy of 84.47%. In relation to parametrial lesions, the sensitivity, speci-ficity, and accuracy of TVS and MRI were as follows: TVS: 9%, 97%, 32%, MRI: 27.14%, 89.19%, and 40.11%. Concerning the uterosacral lesions, the sensitivity, specificity, and accuracy of TVS and MRI were as follows: TVS:14.63%, 94.74%, and 55%, while MRI: 65.88%, 66.30%, and 66.1%. Regarding rectal endometriosis, the sensitivity, specificity, and accuracy of TVS and MRI were as follows: 69.72%, 76.87%, and 73.82% for TVS, and 66.28%, 94.51%, and 80.79% for MRI. The results of the present study indicate that whereas MRI generally exhibits superior capability in assessing the severity of endometriosis, TVS demonstrates sufficient diagnostic accuracy in DIE comparable to MRI.
... Magnetic resonance imaging (MRI) and ultra-sonography are other methods used for endometriosis diagnosis [28]. Patent application RU0002618923 and RU0002757755 describes a modification of MRI method in which the maximum thickness of the connective zone between the endometrium, myometrium, and endometriosis can be identified by measuring blood flow characteristics in uterine tissue in uterine myomas. ...
Objective
The aim of this review is to analyze the patent filings and to systematize the main technological trends in patent protection for the diagnosis and therapeutics for endometriosis. Patent literature has also been explored to identify active inventors and applicants in this field.MethodologyPatent search was carried out in the freely accessible patent search databases namely, patentscope using various combinations of the keywords “Endometriosis OR Adenomyosis” AND “Diagnostic OR Therapeutics” were used along with wildcard search queries in the “Title”, “Abstract” and “Descriptions” fields.ResultsA patent search revealed 144 patents describing inventions for diagnostic and therapeutic purposes of endometriosis. These patents include 26 patent applications in the diagnostic utility and 116 patent applications under the therapeutic approaches. Out of these 116 patent applications, 43 describe traditional medicines for endometriosis. Two patent applications describe inventions that can fall into both categories.Conclusion
Efforts are being made to improve current diagnostic instruments. Hormonal alteration methods is the most common field of invention, followed by surgical interventions for therapeutics. A general trend of increase in patent application filings has been observed with a slight decrease in recent years.
... DIE can involve the Douglas pouch, the rectovaginal septum, the intestine, the anterior pouch, and the uterosacral ligaments. Assessment of this disease is difficult only by physical examination (4)(5)(6)(7). Transvaginal sonography (TVS) is currently considered a fundamental non-invasive diagnostic method to evaluate the extent of DIE within the pelvis and facilitate the choice of a safe and adequate surgical or medical treatment (7-9)". The most common presentations include pelvic pain, infertility, dysmenorrhea, dyschezia, and urinary manifestations. ...
... In this study, bowel DIE had 7.1% sensitivity and, specificity of 98.87%. In the study of Albozi et al. (7). "The TVS, transrectal sonography, and magnetic resonance imaging observed a sensitivity of 100% for the detection of ureteral DIE. ...
... It was unclear as to why some sensitivities were lower than others. In the normal pelvis, the uterosacral ligaments were not seen with ultrasono, which may account for some of the poor accuracies encountered in this region (10,7)." ...
Background:
Endometriosis is a challenging gynecological disease and a debilitating condition that profoundly affects the individual's quality of life. Besides pathological confirmation, diagnostic laparoscopy has been internationally accepted as the standard method to identify the accurate mapping of endometriosis. Transvaginal sonography (TVS) is the first non-invasive imaging modality to estimate the severity of endometriosis.
Objective:
This study aimed to evaluate the accuracy of TVS in affected women compared with surgical findings.
Materials and methods:
This retrospective cross-sectional study surveyed 170 women with deep infiltrating endometriosis (DIE) referred to the endometriosis part of the Avicenna Infertility Center, Tehran, Iran and they underwent TVS followed by laparoscopy. Recorded data of individuals under study in the medical database system were reviewed. Finally, the agreement rate was calculated for ultrasound reports and intraoperative (IO) findings regarding ovarian endometrium, ovarian adhesion, involvement of cul-de-sac, rectovaginal septum, and bowel and ureter.
Results:
170 women with DIE entered the study. The agreement of TVS and IO findings were 86.76% for left ovarian endometriosis and 70.86% for right ovarian endometriosis, 93.90% for left ovarian adhesion, and 88.90% for right ovarian adhesion, 88.90% for a cul-de-sac, and 84.82% for bowel nodules. The findings, based on a laparoscopic assessment of the pelvic floor, were completely compatible with ultrasound reports (100%).
Conclusion:
TVS allows a preoperative evaluation in planning the surgical policy associated. TVS is beneficial for dedicated mapping of DIE; thus, an expert radiologist can aid the surgeon in preoperative evaluation and IO management.
... Endometrioma is seen in ultrasound as a round cyst with a thick wall and ground glass appearance. Ultrasound sensitivity in the diagnosis of endometrioma (OMA) is 83.3% [8]. The presence of endometrioma is associated with more advanced stages of endometriosis disease, which is a sign of disruption of normal pelvic anatomy in affected women [1,2,[9][10][11]. ...
Introduction
Investigation of endometrioma size and its laterality on the quality of the embryo in patients with endometrioma compared to healthy subjects.
Materials and methods
In this retrospective and cross-sectional study, 70 patients with unilateral and bilateral endometrioma were recruited and compared with 70 age-matched infertile patients as the control group in terms of AMH before ovum pick-up, embryo quality as well as pregnancy outcome. Additionally, in the case group, we divided both unilateral (n = 32) and bilateral endometrioma patients (n = 38) into three groups based on the size of endometrioma. (1–3 cm, 3–6 cm, 6–10 cm)
Results
There was no difference in terms of age, BMI, parity, and age of menarche between the case and control groups. Moreover, no significant difference was observed in the baseline level of AMH between the case 2.96 ± 2.72 ng/dl (0.21–11.3) and control 2.73 ± 2.39 (0.21–12.8) groups. (P = 0.59) There was also no significant difference concerning AMH level between unilateral 3.58 ± 3.20 ng/dl (0.21–12.8) and bilateral endometrioma 2.45 ± 2.14 (0.21 − 0.20) groups. In terms of the quality and number of embryos, there was no significant difference between the case and control groups. (P = 0.30) Although the AMH level decreased with the increase in endometrioma size, this difference was not statistically significant. (P = 0.07) There was no significant difference in terms of the embryo quality between the groups based on the size of endometrioma. (P = 0.77) In addition, no significant difference was observed between the case and control groups in the terms of birth weight and pregnancy complications, such as premature delivery, cesarean section rate, neonatal respiratory distress, jaundice, as well as hospitalization rate. Head circumference of the newborns was higher in the endometrioma group while their Apgar score was lower in the case compared to the control group.
Conclusion
The presence of endometrioma by itself does not affect the main result of IVF procedures, including the number and quality of embryos and pregnancy outcome. Thus, IVF and embryo preservation and even pregnancy before surgery seem to be reasonable for endometriotic patients.
