Adherence to or angulation of bowel loops toward the posterior surface of the uterus has been shown to be 83.7% sensitive to diagnose cul-de-sac obliteration, whereas displacement of pelvic free fluid was 95% sensitive and presence of a retrouterine fibrous mass was 97.1% sensitive [40]. These findings may have been enhanced in this study because of the administration of vaginal and rectal sterile US gel as well as an IV antispasmodic. Another study similarly identified serosal uterine fibrotic plaques as having the best accuracy for posterior cul-de-sac obliteration [41] but did not assess displacement of free pelvic fluid. Overall, MRI has value in assessing for endometriomas and other signs of endometriosis, such as angulation of bowel loops toward the posterior surface of the uterus, displacement of pelvic free fluid, and detection of retro-uterine fibrous masses. US Pelvis Color Doppler Endometrial implants have limited vascularity. The presence of Doppler blood flow in a suspected endometrial implant should prompt investigation for neoplasm [42]. Doppler can also be useful in differentiating endometriomas and endometrial implants, which are typically avascular, from other ovarian masses and normal structures [43]. Female Infertility US Pelvis Transrectal Transrectal US can also be useful in the detection of deep infiltrating endometriosis. Compared with surgery, transrectal US was shown to be 97% sensitive and 96% specific for the detection of rectovaginal endometriosis and was 80% sensitive and 97% specific in diagnosing uterosacral ligament implants [44]. In another study, 317 patients underwent pelvic MRI, TVUS, and transrectal US prior to laparoscopy. This study showed transrectal US had the highest sensitivity at 82.8%, but MRI was the most specific at 93.9% for evaluation of the uterosacral ligament, and the three techniques were similar for assessing the rectovaginal septum, bladder, and distal ureters.
Female Infertility. Adherence to or angulation of bowel loops toward the posterior surface of the uterus has been shown to be 83.7% sensitive to diagnose cul-de-sac obliteration, whereas displacement of pelvic free fluid was 95% sensitive and presence of a retrouterine fibrous mass was 97.1% sensitive [40]. These findings may have been enhanced in this study because of the administration of vaginal and rectal sterile US gel as well as an IV antispasmodic. Another study similarly identified serosal uterine fibrotic plaques as having the best accuracy for posterior cul-de-sac obliteration [41] but did not assess displacement of free pelvic fluid. Overall, MRI has value in assessing for endometriomas and other signs of endometriosis, such as angulation of bowel loops toward the posterior surface of the uterus, displacement of pelvic free fluid, and detection of retro-uterine fibrous masses. US Pelvis Color Doppler Endometrial implants have limited vascularity. The presence of Doppler blood flow in a suspected endometrial implant should prompt investigation for neoplasm [42]. Doppler can also be useful in differentiating endometriomas and endometrial implants, which are typically avascular, from other ovarian masses and normal structures [43]. Female Infertility US Pelvis Transrectal Transrectal US can also be useful in the detection of deep infiltrating endometriosis. Compared with surgery, transrectal US was shown to be 97% sensitive and 96% specific for the detection of rectovaginal endometriosis and was 80% sensitive and 97% specific in diagnosing uterosacral ligament implants [44]. In another study, 317 patients underwent pelvic MRI, TVUS, and transrectal US prior to laparoscopy. This study showed transrectal US had the highest sensitivity at 82.8%, but MRI was the most specific at 93.9% for evaluation of the uterosacral ligament, and the three techniques were similar for assessing the rectovaginal septum, bladder, and distal ureters.