From the Department of Radiology, Penn State Health Milton S. Hershey Medical Center, Pennsylvania State College of Medicine, 500 University Dr, Hershey, PA 17033-0850 (B.G.C., S.G., K.L.M.); and Department of Radiology, University of Florida College of Medicine, Jacksonville, Fla (A.A.).
Radiographics. 2019 Sep-Oct;39(5):1549-1568. doi: 10.1148/rg.2019190045.
Transvaginal sonography (TVS) is a valuable primary imaging tool for the initial evaluation and management of endometriosis, a complex multifocal disease process with a varied spectrum of clinical and morphologic features that can substantially affect quality of life. The high accuracy of TVS for the detailed mapping of disease extent, an essential process for guiding treatment strategies, is well documented. The dynamic nature of US provides added value, revealing information that is not easily addressed with other imaging modalities. As recognized by the International Deep Endometriosis Analysis Consensus Group, a dedicated standardized protocol that is used by experienced and knowledgeable operators is necessary for a complete evaluation. The four components of a dedicated TVS protocol for evaluation of pelvic endometriosis are evaluation of the uterus and adnexa, dedicated search for deep infiltrating endometriosis, assessment of the sliding sign, and detection of sonographic soft markers. These components are described, and the multiple locations and US findings of endometriosis within the pelvis are reviewed, with emphasis on the unique features of US as an extension of the physical examination. In addition to enabling evaluation of the static findings of adenomyosis, endometrioma, hydrosalpinx, hematosalpinx, and hypoechoic nodules of deep infiltrating endometriosis, dynamic TVS enables assessment of pouch of Douglas obliteration, organ mobility, and site-specific tenderness, as well as tenderness-guided imaging. The benefits of implementing a dedicated TVS protocol in terms of improved patient care are also discussed. RSNA, 2019.
经阴道超声（TVS）是评估和管理子宫内膜异位症的重要的初始影像学工具，子宫内膜异位症是一种复杂的多灶性疾病，其临床表现和形态特征多种多样，会严重影响生活质量。TVS 对疾病程度进行详细定位的准确性很高，这是指导治疗策略的关键过程，其准确性已得到充分证实。超声的动态特性提供了额外的价值，可以揭示其他成像方式难以捕捉的信息。正如国际深部子宫内膜异位症分析共识小组所认可的，对于全面评估，需要使用经验丰富且知识渊博的操作人员执行专门的标准化协议。用于评估盆腔子宫内膜异位症的专用 TVS 方案的四个组成部分为：评估子宫和附件、专门寻找深部浸润性子宫内膜异位症、评估滑动征和检测超声软指标。本文将对这些组成部分进行描述，并对盆腔内子宫内膜异位症的多个位置和超声表现进行综述，重点介绍超声作为体检延伸的独特作用。除了能够评估腺肌病、卵巢子宫内膜异位囊肿、输卵管积水、血肿和深部浸润性子宫内膜异位症的低回声结节等静态表现外，动态 TVS 还能够评估道格拉斯窝封闭、器官活动度和特定部位压痛，以及压痛引导成像。本文还讨论了实施专用 TVS 方案在改善患者护理方面的益处。RSNA，2019 年。
