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. 2024 Feb;121(2):164-188.
doi: 10.1016/j.fertnstert.2023.12.008. Epub 2023 Dec 14.

Noninvasive diagnostic imaging for endometriosis part 1: a systematic review of recent developments in ultrasound, combination imaging, and artificial intelligence

Jodie C Avery  1 , Alison Deslandes  2 , Shay M Freger  3 , Mathew Leonardi  4 , Glen Lo  5 , Gustavo Carneiro  6 , G Condous  7 , Mary Louise Hull  8 ; Imagendo Study Group  2
Collaborators, Affiliations
Free article

Noninvasive diagnostic imaging for endometriosis part 1: a systematic review of recent developments in ultrasound, combination imaging, and artificial intelligence

Jodie C Avery et al. Fertil Steril. 2024 Feb.
Free article

Abstract

Endometriosis affects 1 in 9 women and those assigned female at birth. However, it takes 6.4 years to diagnose using the conventional standard of laparoscopy. Noninvasive imaging enables a timelier diagnosis, reducing diagnostic delay as well as the risk and expense of surgery. This review updates the exponentially increasing literature exploring the diagnostic value of endometriosis specialist transvaginal ultrasound (eTVUS), combinations of eTVUS and specialist magnetic resonance imaging, and artificial intelligence. Concentrating on literature that emerged after the publication of the IDEA consensus in 2016, we identified 6192 publications and reviewed 49 studies focused on diagnosing endometriosis using emerging imaging techniques. The diagnostic performance of eTVUS continues to improve but there are still limitations. eTVUS reliably detects ovarian endometriomas, shows high specificity for deep endometriosis and should be considered diagnostic. However, a negative scan cannot preclude endometriosis as eTVUS shows moderate sensitivity scores for deep endometriosis, with the sonographic evaluation of superficial endometriosis still in its infancy. The fast-growing area of artificial intelligence in endometriosis detection is still evolving, but shows great promise, particularly in the area of combined multimodal techniques. We finalize our commentary by exploring the implications of practice change for surgeons, sonographers, radiologists, and fertility specialists. Direct benefits for endometriosis patients include reduced diagnostic delay, better access to targeted therapeutics, higher quality operative procedures, and improved fertility treatment plans.

Keywords: Endometriosis; artificial intelligence; combination imaging; diagnosis; ultrasound.

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Conflict of interest statement

Declaration of interests J.C.A. reports grants from Australian Medical Research Future Fund (MRFF), Endometriosis Australia, Australasian Society of Ultrasound in Medicine and Robinson Research Institute. A.D. reports funding from the Australian Government Research Training Program fee offset scholarship, and University of Adelaide higher degree research stipend scholarship, honoraria from Philips Healthcare, as an expert witness opinion provided through experts direct, and is President of Australasian Society for Ultrasound in Medicine. S.M.F. is Board Director and Education Committee Lead for The Endometriosis Network Canada, Policy Analyst and Developer–EndoACT. M.L. reports grants from Australian MRFF, AbbVie, CanSAGE, Hamilton Health Sciences, Hyivy, and Pfizer; honoraria for lectures/writing from AIUM, GE Healthcare, Bayer, AbbVie, TerSera. G.L. receives Honorarium for Abdominal Radiology Group of Australia and New Zealand (ARGANZ) online endometriosis pelvic MRI workshop/course to present an online endometriosis workshop. G.C. reports grants from Australian MRFF, Australasian Society of Ultrasound in Medicine, Honoraria from Samsung, and sponsorship from Stryker, Applied Medical and Medtronic, and is ISUOG Scientific Committee Vice Chair, and WFUMB President elect. He is the Director of Omni Ultrasound and Gynaecological Care Sydney, Australia. G. Carneiro reports grants from the Australian Research Council and MRFF, and British UKRI NIHR and EPSRC. M.L.H. reports grants from Australian MRFF, Endometriosis Australia, Australasian Society of Ultrasound in Medicine, Robinson Research Institute, and the Australian Gynaecological Endoscopy Society, Jean Hails Development Fund, Australian Department of Health. She is paid honoraria from Merck, MSD, Ferring, Guerber, Myovant, Bayer, and Gideon Richter. She is a member of the ASPIRE education committee, the FIGO REI committee and the RANZCOG CREI education committee. She is the Director of Embrace Fertility, Adelaide Australia.

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