Endometriosis: Get It Right the First Time (2025)-M6-COB01-2025

Video Transcription

Video Summary

The session “Endometriosis: Get It Right the First Time” highlights endometriosis as a common, often underdiagnosed disease affecting about 1 in 10 reproductive-age women, causing pain, infertility, and broad systemic symptoms. Speakers emphasize three phenotypes—superficial implants, ovarian endometriomas, and deep infiltrative endometriosis (DE), the most symptomatic and surgically consequential form. Despite prevalence, diagnosis is typically delayed 7–10 years due to social stigma, normalization of symptoms, knowledge gaps among clinicians, nonspecific presentations, and lack of reliable biomarkers.<br /><br />Imaging is positioned as essential for earlier diagnosis and better surgical planning. The SRU consensus introduces an “augmented pelvic ultrasound” requiring minimal extra time (e.g., sliding sign and posterior compartment sweeps) to detect direct signs (endometriomas, bowel/bladder nodules), indirect signs (fixed retroflexed uterus, kissing ovaries, adhesions), and associated findings (adenomyosis, hydrosalpinx). Preliminary validation suggests about one-third of routine pelvic ultrasound patients qualify, and direct findings strongly increase the likelihood of endometriosis.<br /><br />MRI is recommended for persistent symptoms, negative/limited ultrasound, mapping DE, and preoperative planning, using dedicated protocols (small field of view, T2 for detection, T1 for confirmation, antiperistaltic agents, and contrast/subtraction for malignancy evaluation). Myths are addressed: superficial disease can sometimes be seen; endometriosis carries malignancy risk (especially with DE/endometriomas); treatment response varies by phenotype; adolescents can be affected; symptom severity doesn’t reliably match disease extent; pregnancy doesn’t cure endometriosis; and no single diagnostic gold standard exists.<br /><br />Finally, pitfalls and mimickers are reviewed (e.g., bladder underfilling, urachal remnants, surgical scars/hemostatic agents, contractions, vessels, bowel folds/spasm, lymph nodes), underscoring the need for standardized protocols, prior-study correlation, and expert interpretation.

Keywords

endometriosis

deep infiltrative endometriosis (DIE/DE)

ovarian endometrioma

augmented pelvic ultrasound

sliding sign

posterior compartment ultrasound sweep

MRI protocol for endometriosis

preoperative mapping and surgical planning

diagnostic delay and underdiagnosis

imaging pitfalls and mimickers