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Three-Dimensional Sonographic Characteristics of Deep Endometriosis

Department of Obstetrics and Gynecology, University of Cagliari, Cagliari, Italy (S.G., S.A., M.P., G.B.M.); and Clinica Universitaria de Navarra, University of Navarra, Pamplona, Spain, (J.L.A.).

Address correspondence to Stefano Guerriero, MD, Department of Obstetrics and Gynecology, University of Cagliari, Ospedale San Giovanni di Dio, Via Ospedale 46, 09124 Cagliari, Italy. E-mail: gineca.sguerriero{at}tiscali.it

Objective. The purpose of this presentation is to investigate the potential role of 3-dimensional (3D) sonography in the assessment of deep endometriosis. Methods. Cases of deep endometriosis are presented to illustrate the spectrum of appearances obtained with 3D sonography. In addition, we evaluate the possible role of other functions included in 3D equipment, such as the niche mode and tomographic ultrasound imaging (TUI). Results. Three-dimensional image rendering could allow a good analysis of the endometriotic nodule; in fact, in all presented cases, this reconstruction seems to clearly show the irregular shapes and borders of the lesions. This technique allows unrestricted access to an infinite number of viewing planes, which can be very useful for correctly locating lesions within the pelvis and evaluating the relationship with other organs. The stored 3D volumes can be reassessed and compared by the same or different examiners over time. This characteristic may be relevant for monitoring the effect of medical therapies over time. In the niche mode, sonographic imaging is represented as a "cut-open" view of the internal aspect of the nodule and its surrounding tissue. This additional function, which is associated with TUI, could be particularly useful for evaluation of the extension of a nodule in the rectovaginal septum, the depth of infiltration, and the relationship with the rectosigmoid junction or ureter. Conclusions. In the near future, 3D sonography in deep infiltrating endometriosis could be an interesting mode of research with positive effects in everyday clinical practice.

Key Words: deep endometriosis • 3-dimensional sonography • transvaginal sonography

Abbreviations: 3D, 3-dimensional • TUI, tomographic ultrasound imaging • 2D, 2-dimensional