Table 1.

Five domain based TVS approach for the evaluation of the pelvis in women with suspected endometriosis, correlating sono‐morphologic features with predicted phenotypes of endometriosis.

Domains		Objective	Sonologic Sign(S)	Phenotypes of Endometriosis
I		Routine assessment of the uterus and adnexa	Myometrial cysts, streaky echogenic lines, thickened posterior myometrium, loss of endometrial/myometrial interface on 3D Thick walled ovarian cysts with homogenous low level internal echos “Ground glass appearance”	Adenomyosis Endometriomata
II		Tenderness guided assessment	Site specific tenderness	Possible Peritoneal endometriosis
III	IIIa IIIb	Assessment of Organ mobility Ovarian mobility Status of the Pouch of Douglas (POD)	Ovarian immobility Real time dynamic ‘sliding sign’	Ovarian adhesions POD obliteration/Adhesions
IV		Assessing for Non Bowel deep infiltrating endometriosis (DIE) Anterior, lateral and posterior pelvic compartment	Nodules – Solid hypo echoic rounded shape lesions Linear thickenings – Hypo echoic linear thickening Plaques – Hypo echoic lesions With irregular shape.	Extra ovarian non bowel deep infiltrating endometriosis (DIE)
V		Assessment for bowel deep infiltrating endometriosis	Non compressible hypo echoic lesion on muscularis propria (May infiltrate the mucosa layer)	Extra ovarian bowel DIE

Reproduced with Permission from Menakaya, et al.; J Ultrasound Med 20 1 527