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A Review of Advanced Ultrasound Technologies in the Investigation and Management of Endometriosis
INTRODUCTION
Endometriosis is probably the most frequently encountered gynaecological disorder in symptomatic patients attending for ultrasound examination. Its prevalence remains uncertain but appears to affect up to 70% of adolescents with chronic pelvic pain and at least 60% of all patients presenting with pelvic pain, dysmenorrhoea and dyspareunia. Endometriotic lesions have been found in 70-80% of patients with unexplained infertility, and approximately half of those patients have ovarian involvement. The disease is not life threatening but can seriously impair health, cause great distress, and in particular, affect quality of life, certainly during the reproductive years. It has significant social and economic consequences in terms of addressing both associated symptoms as well as treating the condition itself.
The symptoms of endometriosis, and complications caused by its presence, are extremely variable and by no means always related to the extent of the disease. Although there remains a strong association between endometriosis and pelvic pain, evidence of the disease in a signifi cant number of patients occurs as a coincidental finding during surgery or from investigation of other gynaecological conditions such as infertility. Furthermore, symptoms are often similar to those arising from other sources such as disorders of the gastrointestinal or urogenital systems. As a result there is very often a delay in confirming the presence of the disease and a tendency to treat secondary symptoms or focus on other problems before a definite diagnosis is made. Studies suggest that over 30% of women with endometriosis have been symptomatic for at least six years before confi rmation of the disease is made.
The natural history of endometriosis is unclear, somewhat unpredictable and indeed, in some cases, might well improve without treatment. Nevertheless the benefits of early diagnosis of the disease are well recognised. Medical treatment is usually offered as the first-line approach certainly in mild stages of the disease and might also be adopted prior to, or following, planned surgery. Surgical management is obviously indicated in more severe cases although the use of more conservative laparoscopic surgery for earlier staging of the disease has been shown to be increasingly effective in reducing associated pelvic pain, improving quality of life and enhancing fertility.
Extensive experience utilising GE Voluson Expert 730 and E8 systems confirms the impact of modern ultrasound technology in the assessment of endometriosis. Significant improvements in terms of detecting evidence of endometriosis as well as gauging the extent of the disease have without doubt influenced clinical managements.
Author:
Bill SMITH
Head of Ultrasound,
Clinical Diagnostic Services,
London