Preliminary Diagnosis: Endometriosis
I. What imaging technique is first-line for this diagnosis?
Pelvic ultrasound.
II. Describe the advantages and disadvantages of this technique for diagnosing endometriosis.
Advantages
- Does not use ionizing radiation.
- Can easily evaluate the involved structures.
Disadvantages
- Cannot exam all parts of the lower abdomen and pelvis.
- Requires a skilled technician.
- May be difficult to distinguish surrounding soft tissues from the endometrium.
III. What are the contraindications for the first-line imaging technique?
No significant contraindications exist.
IV. What alternative imaging techniques are available?
- CT of the abdomen/pelvis with contrast.
- MRI of the pelvis.
- Hysterosalpingogram (may be used to identify secondary findings, including tubal occlusions or perinexal adhesions).
V. Describe the advantages and disadvantages of the alternative techniques for diagnosing endometriosis.
CT of the abdomen/pelvis with contrast
Advantages
- Excellent anatomical detail.
- Able to clearly differentiate tissue planes.
Disadvantages
- Exposure to ionizing radiation.
MRI of the pelvis
Advantages
- Excellent for assessing soft tissues. Contrast may be utilized to assess variability of enhancement.
Disadvantages
- Expensive.
- Time consuming.
- Requires significant patient cooperation to minimize motion artifact.
Hysterosalpingogram
Advantages
- Relatively easy exam to perform with low radiation exposure.
Disadvantages
- Has small risk of infection or perforation associated with the procedure.
VI. What are the contraindications for the alternative imaging techniques?
CT of the abdomen/pelvis with contrast
Relative contraindication for pregnant women.
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MRI of the pelvis
An absolute contraindication is non-MR compatible hardware.
Hysterosalpingogram
Absolute contraindications include pregnancy, stenotic endocervix, active pelvic inflammatory disease, and recent pelvic surgery and/or biopsy.
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