Urinary obstruction caused by involvement of the ureters or bladder can be silent and associated with loss of renal function [51]. Transabdominal US imaging can also help identify sites of bowel involvement beyond the pelvis, including the appendix, terminal ileum, cecum, and sigmoid [14]. DE TVUS supplemented by transabdominal US imaging was found to accurately predict intraoperative endometriosis staging at a multi-institutional study performed at centers of endometriosis excellence [52]. Variant 2: Adult. Clinically suspected pelvic endometriosis. Indeterminate or negative ultrasound. Next imaging study for characterization or treatment planning. CT Pelvis With IV Contrast There is no relevant literature to support the use of routine pelvic CT with IV contrast as a next imaging study for characterization or treatment planning of suspected pelvic endometriosis. CT Pelvis Without and With IV Contrast There is no relevant literature to support the use of routine pelvic CT without and with IV contrast as a next imaging study for characterization or treatment planning of suspected pelvic endometriosis. CT Pelvis Without IV Contrast There is no relevant literature to support the use of routine pelvic CT without IV contrast as a next imaging study for characterization or treatment planning of suspected pelvic endometriosis. MRI Pelvis Without and With IV Contrast A study that evaluated patients who underwent routine pelvic US and pelvic MRI with IV contrast and later went on to surgery for endometriosis found 51% of patients with a negative US went on to have disease identified on MRI. The same study showed that 78% of patients with endometriosis identified by US were found to have additional sites of disease by MRI [73]. MRI is known to correspond well with surgical staging systems and histopathologic findings [40-43]. Some pelvic MRI classification systems can predict surgical time, length of hospital stay, and postoperative complications [74].
Endometriosis. Urinary obstruction caused by involvement of the ureters or bladder can be silent and associated with loss of renal function [51]. Transabdominal US imaging can also help identify sites of bowel involvement beyond the pelvis, including the appendix, terminal ileum, cecum, and sigmoid [14]. DE TVUS supplemented by transabdominal US imaging was found to accurately predict intraoperative endometriosis staging at a multi-institutional study performed at centers of endometriosis excellence [52]. Variant 2: Adult. Clinically suspected pelvic endometriosis. Indeterminate or negative ultrasound. Next imaging study for characterization or treatment planning. CT Pelvis With IV Contrast There is no relevant literature to support the use of routine pelvic CT with IV contrast as a next imaging study for characterization or treatment planning of suspected pelvic endometriosis. CT Pelvis Without and With IV Contrast There is no relevant literature to support the use of routine pelvic CT without and with IV contrast as a next imaging study for characterization or treatment planning of suspected pelvic endometriosis. CT Pelvis Without IV Contrast There is no relevant literature to support the use of routine pelvic CT without IV contrast as a next imaging study for characterization or treatment planning of suspected pelvic endometriosis. MRI Pelvis Without and With IV Contrast A study that evaluated patients who underwent routine pelvic US and pelvic MRI with IV contrast and later went on to surgery for endometriosis found 51% of patients with a negative US went on to have disease identified on MRI. The same study showed that 78% of patients with endometriosis identified by US were found to have additional sites of disease by MRI [73]. MRI is known to correspond well with surgical staging systems and histopathologic findings [40-43]. Some pelvic MRI classification systems can predict surgical time, length of hospital stay, and postoperative complications [74].