Imaging modalities for the diagnosis of endometriosis in women of reproductive age: A systematic review and meta-analysis
DOI:
https://doi.org/10.37800/RM.2.2026.767Keywords:
endometriosis, imaging diagnostic methods, transvaginal ultrasonography (TVUS), magnetic resonance imaging (MRI)Abstract
Relevance: Endometriosis affects approximately 10% of women of reproductive age and is one of the leading causes of chronic pelvic pain and infertility. Diagnostic delay reaches 7-10 years, underscoring the need for accurate, non-invasive imaging methods.
The study aimed to evaluate the diagnostic accuracy of transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI) for detecting endometriosis in women of reproductive age.
Materials and Methods: A systematic search was performed in PubMed/MEDLINE, Embase, the Cochrane Library, Scopus, and Web of Science (through 31 January 2025) in accordance with PRISMA-DTA 2018; study quality was assessed using QUADAS-2. Eligible studies were original diagnostic accuracy studies enrolling women aged 18-49 years with suspected endometriosis; the index tests were TVUS performed according to the International Deep Endometriosis Analysis (IDEA) protocol or MRI performed according to the protocols of the European Society of Urogenital Radiology (ESUR); the reference standard was laparoscopy with histological verification.
Results: Forty studies were included (28 on TVUS, 12 on MRI; 17 head-to-head comparisons). Pooled sensitivity/specificity for endometrioma were 0.94/0.96 for TVUS and 0.95/0.97 for MRI; for deep infiltrating endometriosis (DIE) of the rectosigmoid, the corresponding values were 0.85/0.92 and 0.83/0.95. For rectovaginal septum involvement, MRI sensitivity was higher than TVUS (0.74 vs. 0.51), with comparable specificity. Direct within-study comparison did not reveal statistically significant differences between the two modalities for rectosigmoid DIE (p = 0.86; p = 0.50).
Conclusion: Expert-performed TVUS using the IDEA protocol and MRI using the ESUR protocol are consistent diagnostic tests for detecting endometrioma and rectosigmoid DIE and serve as complementary first-line modalities. MRI offers an advantage in cases of rectovaginal septum involvement and multicompartmental disease. In light of the classification proposed by the American and Global College of Endometriosis Specialists (AGCES), which provides a distinct assessment of the genital and extragenital components of the disease, standardized imaging is key for stratifying clinical phenotypes. For Kazakhstan, prospective local validation of these imaging methods remains a priority.
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