IMAGING ASSESSMENT OF DEEP ENDOMETRIOSIS: A COMPARISON BETWEEN TRANSVAGINAL ULTRASONOGRAPHY AND MAGNETIC RESONANCE IMAGING

Abstract

Deep endometriosis is a chronic gynecological disease characterized by the presence of endometrial tissue in pelvic organs and, in some cases, extra-pelvic sites, associated with pelvic pain, dysmenorrhea, dyspareunia, and infertility. Although laparoscopy with histological confirmation is still considered the gold standard for definitive diagnosis, its invasive nature and high cost reinforce the importance of noninvasive imaging methods. This study aimed to compare the accuracy of transvaginal ultrasonography and magnetic resonance imaging in the evaluation of deep endometriosis. An integrative literature review was conducted using articles published in PubMed/MEDLINE, Scielo, and Google Scholar between 2010 and 2025, with 20 articles selected. The results showed that transvaginal ultrasonography, in addition to being low-cost and widely accessible, has good sensitivity for intestinal and ovarian lesions, especially when performed by experienced examiners. Magnetic resonance imaging, on the other hand, demonstrated greater accuracy in identifying deeply infiltrating lesions, including retrocervical involvement, uterosacral ligaments, and the pouch of Douglas, being essential for surgical planning. It is concluded that both techniques are complementary: transvaginal ultrasonography should be considered the initial examination, while magnetic resonance imaging is indicated for complex cases and those with greater anatomical extension, enhancing diagnostic accuracy when used in an integrated manner.