Research summary

The Society of Radiologists in Ultrasound Provide Consensus Statement on Routine Pelvic Ultrasound for Endometriosis

A recent consensus statement released in April by the Society of Radiologists in Ultrasound (SRU) outlines recommendations to health care providers to improve the imaging, detection and evaluation of endometriosis in patients.

Endometriosis is a common condition that is associated with infertility and subfertility, affecting 20% to 50% of patients with these conditions. The disease is a potentially debilitating condition that affects 10% of those of reproductive age. The most severe form of endometriosis—deep endometriosis (DE)—was redefined in 2021 as “extending to any depth beneath the peritoneal surface.”

“The purpose of this consensus panel is to recommend methods that increase the diagnostic sensitivity for endometriosis at pelvic [ultrasound] by increasing awareness, improving interpretation, adding simple techniques that are high yield for DE, and improving protocols to triage patients” the authors, a multidisciplinary panel of experts, wrote. “The recommendations are expected to add minimal time to the current recommended protocols.”

Ultrasound is typically the first-line imaging modality that health care providers use when patients report the possible symptoms of endometriosis, but, according to the authors, it is rarely used to screen for DE. According to the authors’ consensus statement, there are three essential recommendations to note for screening:

  • Performing augmented pelvic ultrasound in patients who are premenopausal or early menopausal who are symptomatic for or have a history of endometriosis or infertility.
  • Performing augmentation techniques such as transvaginal ultrasound of the posterior compartment, observation of the relative positioning of the patient’s uterus and ovaries, and the uterine sliding sign maneuver (transducer pressure or bimanual demonstration of uterine mobility).
  • Health care providers should observe, both directly and indirectly, DE and should be assessed during the examination. Further, results should be reported using four categories:
    • Incomplete (augmented pelvic ultrasound, or APU-0)
    • Normal (APU-1)
    • Equivocal (APU-2)
    • Positive (APU-3)

The comprehensive consensus includes detailed imaging examples, diagrams and illustrations, and videos for health care providers to thoroughly understand the recommendations provided by the panel.

“Endometriosis is a common condition with substantial diagnostic delay, leading patients to experience pain, infertility, lost wages, and interrupted relationships. Ultrasound is the first-line imaging modality to evaluate pelvic pain,” the authors concluded. “The Society of Radiologists in Ultrasound consensus regarding routine pelvic ultrasound for endometriosis aims to enhance DE detection even at an initial ultrasound and with minimal additional time during imaging and no special patient preparation.”


Young SW, Jha P, Chamié L, et al. Society of Radiologists in Ultrasound consensus on routine pelvic US for endometriosis. Radiology. Published online April 9, 2024. doi:10.1148/radiol.232191