Ultrasound features of ovarian endometriomas

The purpose of the study was a detailed evaluation of the ultrasound features of the ovarian endometriomas (endometrioid cysts) in pre- and postmenopause. Material and methods . 155 patients (150 premenopausal and 5 postmenopausal) with morphologically proven endometrioid cysts were examined. A total of 259 endometriomas in premenopause and 6 endometriomas in postmenopause were found in 155 patients. Lesions described in accordance with the recommendations of the IOTA group. Prospective risk stratification of endometrioma malignancy was performed using the O-RADS v2022 ultrasound classification. Statistical processing of the data was carried out using standard statistical methods. Results . In more than 15% of cases of ovarian endometriosis in premenopause, two or more endometriomas can be found in the involved ovary, and in every third patient, both ovaries are involved in the process. The following ultrasound signs characterized the majority of endometriomas in premenopause: a unilocular lesion with smooth internal contours with "ground glass” internal contents ± dotted echogenic foci in the wall ± solid/papillary avascular component. In approximately every tenth premenopausal endometrioma, other types of internal contents may be determined rather than “ground glass” (anechoic, rare echogenic suspension, liquid-liquid level, mixed echogenicity). In most postmenopausal endometriomas, mixed echogenicity, solid components with vascularization, septations with vascularization, and an irregular internal contour are very common. Conclusions : Most endometriomas in premenopausal women have typical signs that allow them to be confidently diagnosed by ultrasound. However, it can be exceedingly challenging to distinguish postmenopausal endometriomas from malignant lesions since they commonly lack the typical signs. Thus, an ultrasound conclusion of the presence of endometrioma in postmenopausal women is inappropriate.