Role of Ultrasound in diagnosis

Endometriosis and Adenomyosis :IDEA & MUSA

Riswan Hasan
HIFERI PALEMBANG
Endometriosis
vs
Adenomyosis
The Doctor’s Thinking Loop in Endometriosis:
From Diagnosis to Comprehensive Treatment
2D US Examination Recommendations for
Endometriosis
• Start with abdominal scan: global
assessment and kidney for hydronephrosis
• Optimize the image: keep good contact
with the structures
• Systematic scan: sagital then transverse
• Slow movement!
• Use another hand to push bowel, to keep
the organs in good contact with the probe
• Observe for pain and tenderness
• Beware of probe position:
anterior/posterior fornix
ENDOMETRIOSIS
Insiden 5% wanita

Ditemukan di banyak tempat di seluruh panggul,

khususnya ovarium, peritoneum, kavum Douglas
(POD), rektum, rektosigmoid, septum rektovaginal
(RVS), ligamen uterosakral (USL), vagina dan
kandung kemih.

Diagnosis spesifik lokasi yang tepat merupakan

hal mendasar dalam menentukan strategi
pengobatan optimal untuk endometriosis.

Metode pencitraan non-invasif diperlukan

untuk memetakan lokasi dan luas lesi
endometriotik secara akurat.
Systematic approach to sonographic evaluation of the pelvis in women with suspected
endometriosis, including terms, definitions and measurements: a consensus opinion from the
International Deep Endometriosis Analysis (IDEA) group

Ultrasound in Obstet & Gyne, Volume: 48, Issue: 3, Pages: 318-332, First published: 28 June 2016, DOI: (10.1002/uog.15955)
1st STEP...
Periksa :
- Uterus : normal, adenomyosis
- Adnexa : endometrioma,
adhesi

2nd STEP..
soft marker àkemungkinan endometriosis dan
perlengketan superfisial.
Endometrioma
• High accuracy by TVUS
• Ovarian mobility : uterus, pelvic side wall, rectum, contralateral
adnexa
• Presence of hydrosalphinx/ hematosalphinx
• Numbers of cyst locus
• Papilary growth and other malignant signs
3rd STEP...
Menilai status POD memakai TVS real-time
Sliding sign
POD obliteration
4th STEP...
Anterior & Posterior Compartemen Nodule
Anterior Compartemen
Posterior Compartemen
Bowel deep infiltrating endometriosis (DIE).
(a) DIE nodule with a regular outline
(absence of ‘spikes’).
(b) DIE nodule with progressive narrowing,
like a ‘tail’, also known as ‘comet’ sign.
(c) DIE nodule with prominent spikes
towards the bowel lumen, also known
as ‘Indian headdress’ or ‘moose antler’
sign.
(d) DIE nodule with both prominent spikes
towards the bowel lumen (Indian
headdress/moose antler sign) and
progressive narrowing like a tail (comet
sign)
(e) DIE nodule with both prominent spikes
towards the bowel lumen (Indian
headdress/moose antler sign) and
extrinsic retraction (and visible mucosal
folds) (known as ‘pulling sleeve’ sign).
(f) DIE nodule and extrinsic retraction
(pulling sleeve sign).
ADENOMYOSIS
Sekitar 19,5% pada perempuan usia reproduktif

TIPE

FOCAL : kumpulan nodul

DIFFUSE: berbagai kelompok kelenjar dan stroma

endometriotik didistribusikan ke seluruh miometrium

CYSTIC : tampak sebagai kista besar (adenomioma kistik)

DIAGNOSIS
MUSA
Morphological Uterus Sonographic Assessment
The junctional zone (JZ)

(a) regular (b) irregular (c) interrupted (d) not visible

Ultrasound Obstet Gynecol 2015; 46: 284–298.
Types Of Lesion Echogenicity
a. uniform (hypoechogenic)
b. isoechogenic
c. hyperechogenic
d. non-uniform (with mixed
echogenicity
e. echogenic areas
f. cystic areas

Ultrasound Obstet Gynecol 2015; 46: 284–298.

Shadowing

a. edge shadowing
b. internal shadowing
c. fan-shaped shadowing
The lower image also
shows an anechogenic
myometrial cyst with a
hyperechogenic rim
surrounding the cyst and
acoustic enhancement
posterior to the cyst

Ultrasound Obstet Gynecol 2015; 46: 284–298.

The Vascular Pattern

a. uniform
b. non uniform

c. circumferential
d. intralesional
e. both

Ultrasound Obstet Gynecol 2015; 46: 284–298.

Adenomyosis
• High accuracy by TVUS
• Diffuse / focal
• Uterine cavity distortion
• Adhesion to adnexas / bowel
• POD obliteration
Take Home Message
• Ultrasound is a first line and powerful tools in diagnosing endometriosis and
adenomyosis
• What kind of endometriosis and adenomyosis ? IDEA and MUSA
classification
• Role of OBGYN specialist: to triage endometriosis staging pre-operatively
• To facilitate surgery: Entity diagnosis is not sufficient: Anatomy topography
diagnosis is mandatory.