Search

Objective: To describe the sonomorphological changes and appearance of deep endometriosis (DE) affecting the nervous tissue of the sacral plexus (SP). Methods: This was a retrospective study of symptomatic patients who underwent radical resection of histologically confirmed DE affecting the SP and who had undergone preoperative transvaginal sonography (TVS) between 2019 and 2023. Lesions were described based on the terms and definitions of the International Deep Endometriosis Analysis (IDEA), International Ovarian Tumor Analysis (IOTA) and Morphological Uterus Sonographic Assessment (MUSA) groups. A diagnosis of DE affecting the SP on TVS was made when the sonographic criteria of DE were visualized in conjunction with fibers of the SP and the presence of related symptoms corresponding to sacral radiculopathy. Clinical symptoms, ultrasound features and histological confirmation were analyzed for each patient included. Results: Twenty‐seven patients with DE infiltrating the SP were identified in two contributing tertiary referral centers. Median age was 37 (range, 29–45) years and all patients were symptomatic and presented one or more of the following neurological symptoms: dysesthesia in the ipsilateral lower extremity (n = 17); paresthesia in the ipsilateral lower extremity (n = 10); chronic pelvic pain radiating in the ipsilateral lower extremity (n = 9); chronic pain radiating in the pudendal region (n = 8); and motor weakness in the ipsilateral lower extremities (n = 3). All DE lesions affecting the SP were purely solid tumors in the posterior parametrium in direct contact with, or infiltrating, the S1, S2, S3 and/or S4 roots of the SP. The median of the largest diameter recorded for each of the DE nodules was 35 (range, 18–50) mm. Echogenicity was non‐uniform in 23 (85%) of the DE nodules, with all but one of these nodules containing hyperechogenic areas. The shape of the lesions was irregular in 24 (89%) cases. Only one lesion exhibited a lobulated form, with all other irregular lesions showing a spiculated appearance. An acoustic shadow was produced in 20 (74%) of the nodules, all of which were internal. On color or power Doppler examination, 21 (78%) of the nodules showed no signal (color score of 1). The remaining six (22%) lesions showed a minimal color content (color score of 2). According to pattern recognition, most DE nodules were purely solid, non‐uniform, hypoechogenic nodules containing hyperechogenic areas, with internal shadows and irregular spiculated contours, and were poorly vascularized on color/power Doppler examination. Conclusion: The ultrasound finding of a parametrial, unilateral, solid, non‐uniform, hypoechogenic nodule with hyperechogenic areas and possible internal shadowing, as well as irregular spiculated contours, demonstrating poor vascularization on Doppler examination in proximity to or involving the structures of the SP, indicates DE affecting the SP. © 2024 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objective: To investigate the feasibility of identifying and measuring the normal sacral plexus (SP) on gynecological transvaginal ultrasound (TVS) examination. Methods: This was a prospective observational study conducted at a single tertiary gynecological referral center, including consecutive women undergoing TVS for various indications between November 2021 and January 2022. A standardized assessment of the pelvic organs was performed and the presence of any congenital or acquired uterine pathology or ovarian abnormality was recorded. Visualization of the right and left SP was attempted in all cases. The success rate and the time needed to identify the SP were recorded and measurements of the SP were made. Results: A total of 326 patients were included in the study. In all women, the SP was identified successfully on at least one side. SP were visualized bilaterally in 317 (97.2% (95% CI, 94.4–98.5%)) women. Only the right SP was seen in 3/326 (0.9% (95% CI, 0.2–2.7%)) and only the left in 6/326 (1.8% (95% CI, 0.6–4.0%)) (P = 0.5048). There was no significant difference in the median time required to visualize the right vs left SP (9.0 (interquartile range (IQR), 8.0–10.0) s vs 9.0 (IQR, 8.0–10.0) s; P = 0.0770). The median transverse diameter of the right SP was 15.0 (IQR, 14.2–15.6) mm and that of the left SP was 14.9 (IQR, 14.4–15.6) mm. Conclusions: We describe a novel method which allows for the consistent and rapid identification of the SP on TVS. Integrating assessment of the SP into routine pelvic TVS may be helpful particularly for women suffering from deep endometriosis. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

This article, published in the journal Ultrasound in Obstetrics & Gynecology, discusses a study that aimed to investigate the feasibility of visualizing the piriformis muscle (PM) and the sacral nerves using gynecological transvaginal ultrasound (TVS). The study included 305 patients and found that the PM was visualized in 96.4% of cases on the right side and 96.0% on the left side, with median antero-posterior (AP) diameters of 18.3mm and 18.4mm, respectively. The sacral nerves (S1-S3) were visualized in 81.6% of cases on the right side and 81.0% on the left side, with median AP diameters of 4.8mm. The authors suggest that integrating the assessment of these structures into routine pelvic TVS may be beneficial for women with deep endometriosis. [Extracted from the article]

Bladder DE was in 78/98 (80%), ureteral DE in 8 (8%) both ureteric and bladder DE in 12 (12%) patients present. Patients with UTE infiltrating the bladder were undergoing surgical treatment by dissection using a skinning technique or partial cystectomy. To test the accuracy of IDEA criteria for suspected urinary tract endometriosis (UTE) and to determine the distribution, size and consequences of UTE. [Extracted from the article]

Objective: To identify the sonomorphological appearance and to measure the thickness of the piriformis muscle (PM) and the proximal portion of the sacral nerve roots S1-S3 in healthy premenopausal women., Materials and Methods: This prospective multicentric observational study included a consecutive series of women undergoing transvaginal sonography (TVS) at two tertiary gynecological referral centers. Standardized assessment of the pelvic organs was performed followed by an attempt to visualize the right and left PM and sacral nerve roots S1-S3 at their origin in proximity to the sacral neuroforamen. Visualization rates, diameters of the muscle and nerve thickness and the time needed to identify the PM were recorded., Results: 305 patients were included in the study. In 293 women (96.1%) PM was identified bilaterally. The median diameter of the right PM was 18.3mm and 18.4mm on the left side. S1 nerve roots were succesfully identified bilaterally in 224 (73.4%) patients. Their right and left median diameters were 4.8mm. Both S2 nerves were succesfully identified in 215 (70.5%) patients. Their median diameter were 4.3mm on both sides. S3 nerve roots were succesfully identified in 203 (66.6%) patients. Their median diameter were 3.2mm on both sides., Conclusion: We describe methods which allow consistent and rapid identification of the PM and the S1-S3 sacral nerve roots using TVS. Visualization of the PM and the proximal portion of the sacral plexus may be useful regarding identification of pathological changes in PM thickness and could help to distinguish perineural cysts from other gynecological pathologies. Ziel: Die Beschreibung der sonomorphologischen Merkmale als auch die standardisierte Messung des Durchmessers des Musculus piriformis (PM) und der proximalen Anteile der Sakralnervenwurzel (SNW) S1-S3 bei prämenopausalen Frauen., Material Und Methoden: Diese prospektive Beobachtungsstudie umfasste konsekutiv untersuchte Patientinnen an zwei tertiären gynäkologischen Referenzzentren. Nach standardisierter Beurteilung der Beckenorgane wurde versucht beide PM, deren Durchmesser und die proximalen Anteile der SNW S1-S3 an ihrem Ursprung in der Nähe des Sakralneuroforamens transvaginalsonografisch (TVS) darzustellen. Ergebnisse: Von 305 wurden bei 293 (96,1%) Patientinnen der PM beidseitig detektiert. Der mediane Durchmesser des rechten PM betrug 18,3 mm und des linken PM lag bei 18,4 mm. Die S1-Nervenwurzel (NW) wurde beidseitig bei 224/305 (73,4%) Patientinnen erfolgreich identifiziert. Der mediane Durchmesser der S1-NW betrug an beiden Seiten 4,8 mm. Beide S2-NW wurden bei 215/305 (70,5%) Patientinnen erfolgreich identifiziert. Der mediane Durchmesser der S2-NW betrug 4,3 mm an beiden Seiten. Schließlich wurden bei 203/305 (66,6%) Patientinnen S3-NW erfolgreich identifiziert. Der mediane Durchmesser der S3-NW betrug 3,2 mm an beiden Seiten. Schlussfolgerungen: Die Identifizierung des PM durch TVS ist allermeist möglich mit obig angegebenen Referenzwerten der PM-Dicke. Die SNW S1-S3 können bei der Mehrheit der Patientinnen mittels TVS an ihrem Ursprung identifiziert werden. Die Visualisierung des PM und des proximalen Anteils des Plexus Sacralis ist bei pathologischen Veränderungen des PM oder der Differentialdiagnose von Adnextumoren und Perineuralzysten von Bedeutung., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Objectives:  To test the accuracy of TVS applying the IDEA approach for suspected rectosigmoid DE and to determine the frequency of other pelvic diseases mimicking DE in patients undergoing surgery., Materials Und Methods:  Prospective single center observational study including consecutive women undergoing TVS for clinically suspected rectosigmoid DE followed by conservative or surgical therapy. TVS findings were compared with those obtained by laparoscopy and confirmed histologically., Results:  Of the 671 included patients, 128 women opted for medical therapy, and 6 patients decided for surgery but did not give consent to participate in the study. 537 women were enrolled in the final analysis. 279 (52 %) exhibited surgically confirmed rectosigmoid DE. The sensitivity and specificity, positive and negative predictive value (PPV, NPV), positive and negative likelihood ratio (LR+/-) and accuracy of TVS for diagnosing DE in the rectosigmoid were 93.5 %, 94.6 %, 94.9 %, 93.1 %, 17.24, 0.07, 94.04 %. 12 women who were clinically suspected for DE and mimicked sonographic signs fulfilling the IDEA criteria did exhibit other pathologies. Diagnoses were as follows: vaginal Gartner duct cyst (3/291;1.0 %), anorectal abscess (3/291; 1.0 %), rectal cancer (2/291;0.7 %), hydrosalpinx (2/291;0.7 %), metastatic endometrial cancer (1/291;0.35 %) and Crohn's disease (1/291;0.35 %)., Conclusion:  TVS for diagnosing colorectal DE applying the IDEA criteria is highly accurate for presurgical diagnosis. However, additional pelvic pathologies are encountered in 4-5 % of women attending for suspected rectosigmoid DE. These need to be taken into account when investigating patients for suspected DE., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)