How to Perform Ultrasonography in Endometriosis PDF
Preview How to Perform Ultrasonography in Endometriosis
How to Perform Ultrasonography in Endometriosis Stefano Guerriero George Condous Juan Luis Alcázar Editors 123 How to Perform Ultrasonography in Endometriosis Stefano Guerriero George Condous • Juan Luis Alcázar Editors How to Perform Ultrasonography in Endometriosis Editors Stefano Guerriero George Condous Department of Obstetrics and Acute Gynaecology, Early Pregnancy Gynecology and Advanced Endosurgery Unit University of Cagliari Sydney Medical School Nepean Cagliari University of Sydney Italy Nepean Hospital Sydney, Australia Juan Luis Alcázar Obstetrics and Gynecology Department University of Navarra Pamplona Spain ISBN 978-3-319-71137-9 ISBN 978-3-319-71138-6 (eBook) https://doi.org/10.1007/978-3-319-71138-6 Library of Congress Control Number: 2018950453 © Springer International Publishing AG, part of Springer Nature 2018 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Printed on acid-free paper This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland Preface How to Perform Ultrasonography in Endometriosis is an international col- laborative which brings together experts in the different fields of endometrio- sis, with a special focus on imaging. This book primarily aims to give sonologists, radiologists and sonographers a blueprint which enables them to understand not only the different phenotypes and anatomical locations of endometriosis but also the steps involved when performing an ultrasound- based evaluation in a woman with potential underlying endometriosis. Before the recent 2016 publication on the systematic approach to ultra- sound in women with suspected endometriosis by the International Deep Endometriosis Analysis (IDEA) group, there was significant heterogeneity in the scientific literature in nomenclature, definitions and components of this particular type of ultrasound scan. The dynamic ultrasound-based evaluation of the pelvis in women with potential endometriosis is divided into four dis- tinctive systematic steps as defined by the IDEA group. In this book, we have taken each of the four steps and dissected every aspect of the ultrasound eval- uation so that the reader is clearly guided and gets a clear understanding of what is involved. The format of each chapter includes a ‘short update’, ‘how we do it’, ‘technical tips’ and ‘future perspectives’ to thoroughly assist the reader in the intricacies of all aspects of the patient evaluation. We have also included where relevant pictorials, images and videos to illustrate different aspects of the specific imaging evaluation being discussed. Step one of the IDEA approach includes both assessment of the uterus and ovaries. In this ‘how-to’, we go into great detail examining and explaining the methodology behind uterine and myometrial evaluation as adopted by the Morphological Uterus Sonographic Assessment (MUSA) group. We also elaborate on the classification of ovarian endometrioma according to the International Ovarian Tumor Analysis (IOTA) group. Step two of the IDEA approach evaluates ‘soft markers’ including ovarian mobility and site-specific tenderness. Again in this ‘how-to’, great insight is given to this important dynamic aspect of the ultrasound-based evaluation. Step three of the IDEA approach evaluates the status of the pouch of Douglas (POD). This is explained in the ‘how-to’ with implementation of the ‘sliding sign’ which is also a dynamic part of the ultrasound-based evaluation. Step four of the IDEA approach evaluates the anterior and posterior com- partments of the pelvis for the presence or absence of deep endometriosis. We have allocated separate and detailed chapters in the ‘how–to’ on the ultrasound v vi Preface evaluation of specific deep endometriosis anatomical locations, including the bladder and ureters, the uterosacral ligaments, the posterior vaginal fornix and the rectum–rectosigmoid–sigmoid. We have also outlined extra-pelvic sites for endometriosis and discussed other modified ultrasonographic techniques as well as additional radiological techniques including magnetic resonance imaging. In broadening the content of this ‘how-to’ book, we believed it was impor- tant to include chapters on the clinical and anatomical considerations of endometriosis, an up-to-date overview on medical and surgical management strategies and currently available biomarkers being used and evaluated in endometriosis. These evidence-based chapters give an update in these key areas of the disease. We hope that when reading this book you become well versed in the detail involved in assessing women with endometriosis. The incredibly relevant experience shared by the different co-authors throughout this ‘how-to’ com- mentary should educate and expand your knowledge in this rapidly evolving field of endometriosis imaging. The simplification of the IDEA approach through pictorials, images and videos should empower you in your endeav- ours to improve your diagnostic performance in endometriosis ultrasound. In turn, this will enable you to not only map disease location but more impor- tantly convey important information about the extent of disease. Enjoy. Cagliari, Italy Stefano Guerriero Sydney, New South Wales, Australia George Condous Pamplona, Spain Juan Luis Alcazar Contents 1 Endometriosis: Clinical and Anatomical Considerations . . . . . 1 Sukhbir S. Singh 2 Medical and Surgical Management of Endometriosis . . . . . . . . 13 Errico Zupi, Lucia Lazzeri, and Caterina Exacoustos 3 Standardized Ultrasonographic Diagnostic Protocol to Diagnose Endometriosis Based on the International Deep Endometriosis Analysis (IDEA) Consensus Statement . . . . . . . 27 Mathew Leonardi and George Condous 4 Uterine Evaluation Using a Diagnostic Protocol Based on MUSA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Thierry Van den Bosch 5 Ovarian Endometriosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Juan Luis Alcázar 6 Soft Marker Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Shannon Reid 7 Ultrasound in the Evaluation of Pouch of Douglas Obliteration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Shannon Reid 8 Anterior Compartment Including Ureter . . . . . . . . . . . . . . . . . . 67 Luca Savelli and Maria Cristina Scifo 9 Uterosacral Ligament Endometriosis . . . . . . . . . . . . . . . . . . . . . 77 Francesco Paolo Giuseppe Leone 10 Forniceal-Vaginal Deep Endometriosis . . . . . . . . . . . . . . . . . . . . 89 Stefano Guerriero, Gil Cohen, Silvia Ajossa, Ornella Comparetto, Camilla Ronchetti, Bruno Piras, Alba Piras, and Valerio Mais 11 Rectovaginal Septum Endometriosis . . . . . . . . . . . . . . . . . . . . . . 97 Gernot Hudelist and Kristine Aas-Eng 12 Rectum, Rectosigmoid, and Sigmoid Endometriosis . . . . . . . . . 103 Manoel Orlando Goncalves, Leandro Accardo de Mattos, and Mauricio S. Abrao vii viii Contents 13 Other Locations of Deep Endometriosis . . . . . . . . . . . . . . . . . . . 121 Stefano Guerriero, Silvia Ajossa, Ornella Comparetto, Camilla Ronchetti, Virginia Zanda, Bruno Piras, Alba Piras, and Valerio Mais 14 Modified Ultrasonographic Techniques . . . . . . . . . . . . . . . . . . . 133 Simone Ferrero, Umberto Leone Roberti Maggiore, Fabio Barra, and Carolina Scala 15 Additional Radiological Techniques (MRI) . . . . . . . . . . . . . . . . 147 Federica Schirru, Stefano Guerriero, and Luca Saba 16 Biomarkers in Endometriosis . . . . . . . . . . . . . . . . . . . . . . . . . . . 169 Vicki Nisenblat and M. Louise Hull 17 Clinical Cases and Videos ............................... 185 Mauricio León, Hugo Sovino, and Juan Luis Alcazar Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191 List of Videos Video 1.1 Scar endometriosis—An example of a post cesarean section inci- sional endometriosis nodule resulting in cyclical left lower quad- rant pain and a palpable mass. (Courtesy of Dr. S. Singh) Video 1.2 Excision of superficial endometriosis—An educational video. (Courtesy of Dr. M. Suen) Video 1.3 Surgical approach to endometriosis of the posterior cul-de-sac. (Courtesy of Dr. D. Evans and M. Suen) Video 1.4 Video demonstrating excision of an invasive bladder nodule. (Courtesy of Dr. S. Singh) Video 5.1 In this video, acoustic streaming in a case of ovarian endometri- oma can be observed. Note the movement of the cyst’s particles Video 5.2 In this case, the adhesion of the ovary to the uterus is clearly noted when moving the transvaginal probe back and forth Video 5.3 In this case, the ovarian endometrioma is not attached to the uterus, and we can observe the sliding of the cyst against the cervix Video 5.4 This video corresponds to a case of endometrioma decidualiza- tion during pregnancy. A highly vascularized cystic solid mass can be seen. The cyst was surgically removed, and histologic analysis proved it was a decidualized endometrioma Video 6.1 Transvaginal ultrasound is used to demonstrate a mobile right ovary (RO) along the right pelvic sidewall (RPSW) in the trans- verse plane. EIV external iliac vessel Video 6.2 Transvaginal ultrasound is used to demonstrate ovarian (O) mobility along the lateral uterus (U), as well as the right pelvic sidewall (PSW), in the transverse plane Video 6.3 Transvaginal ultrasound is used to demonstrate fixation of the left ovary (LO) to both the posterior uterus (U) and left pelvic sidewall (LPSW), in the sagittal plane Video 6.4 Transvaginal ultrasound is used to demonstrate fixation between the left ovary (O) and the posterior uterine cervix (C), in the sag- ittal plane Video 7.1 (a) Transvaginal ultrasound is used to demonstrate a positive “sliding sign” between the anterior rectum and posterior uterine cervix/retro-cervix (C) in the sagittal plane. POD pouch of Douglas. (b) Transvaginal ultrasound is used to demonstrate a positive “sliding sign” between the rectosigmoid bowel and posterior uterine fundus (U) in the sagittal plane ix x List of Videos Video 7.2 (a) Transvaginal ultrasound is used to demonstrate a negative “sliding sign” between the anterior rectum (R) and posterior uterine cervix/retro-cervix (C) in the sagittal plane. (b) Transvaginal ultrasound is used to demonstrate a negative “slid- ing sign” between the rectosigmoid bowel (RS) and posterior uterine fundus (U) in the sagittal plane Video 7.3 (a, b) Transvaginal ultrasound is used to demonstrate a positive “sliding sign” for a retroverted uterus, at both the posterior uter- ine fundus and anterior lower uterine segment, respectively (sag- ittal plane). In Video (a), the anterior rectum glides freely over the posterior uterine fundus. In Video (b), the rectosigmoid bowel glides freely over the anterior lower uterine segment. U uterus Video 8.1 Normal anterior pelvic compartment. Note the sliding of the bladder and uterus. The bladder wall has normal shape and morphology Video 8.2 Normal posterior pelvic compartment. Note the sliding of the rectum and uterus. The vaginal wall, uterosacral ligaments, and anterior rectal wall appear normal and the sliding sign is positive Video 8.3 Transvaginal sagittal scan of the bladder showing a ureteral jet Video 10.1 Tenderness-guided evaluation of a forniceal nodule Video 10.2 Tenderness-guided evaluation of a diabolo-like nodule Video 10.3 A forniceal nodule evaluated without sonovaginography Video 10.4 The same nodule evaluated using sonovaginography Video 13.1 An ultrasonographic evaluation of a scar endometriosis in a 32-year-old woman with a cesarean section 6 years before with uncorrect focalization Video 13.2 An ultrasonographic evaluation of a scar endometriosis in the same patient of Video 13.1 but with a better focalization Video 13.3 A color Doppler scan of the same nodule of Videos 13.1 and 13.2 Video 13.4 An ultrasonographic evaluation of two nodules of scar endome- triosis in a 39-year-old woman with a previous cesarean section 6 years before Video 13.5 An ultrasonographic evaluation of two nodules of scar endome- triosis in a 39-year-old woman with a previous cesarean section 6 years before Video 13.6 An ultrasonographic evaluation of Villar’s nodule in a 33-year- old woman without previous abdominal surgery Video 13.7 An ultrasonographic color Doppler evaluation of Villar’s nodule in a 33-year-old woman without previous abdominal surgery Video 13.8 An ultrasonographic evaluation of a rectus abdominis endome- triosis in a 30-year-old woman with one previous cesarean sec- tion 4 years before Video 13.9 An ultrasonographic color Doppler evaluation of a rectus abdominis endometriosis in a 30-years-old woman with one pre- vious cesarean section 4 years before
The list of books you might like
