Abstract
BACKGROUND: Accurate preoperative staging of endometrioma (EC) is essential for optimal treatment planning. This study aims to evaluate the diagnostic performance of intravenous contrast-enhanced ultrasound (IV-CEUS) as a potential modality for EC staging. METHODS: This retrospective study involved 71 patients with histologically confirmed EC who were admitted to Tianjin Central Hospital of Gynecology Obstetrics between January 2021 and August 2024. All patients had undergone both IV-CEUS and magnetic resonance imaging (MRI) within 14 days before surgery. IV-CEUS was performed using high-end Doppler ultrasound systems with SonoVue(®) contrast, while MRI was conducted on a 1.5 T scanner employing T2 weighted, diffusion-weighted, and dynamic contrast-enhanced sequences. Deep myometrial invasion (DMI; ≥ 50%) and cervical stromal invasion (CSI) were assessed, with final histopathological findings serving as the reference standard. Diagnostic performance was evaluated using sensitivity, specificity, predictive values, accuracy, Kappa coefficients, and receiver operating characteristic (ROC) curves. RESULTS: For DMI diagnosis, IV-CEUS demonstrated a sensitivity of 74.2%, specificity of 92.5%, PPV of 88.5%, NPV of 82.2%, and accuracy of 84.5% (κ = 0.68). MRI showed a sensitivity of 90.3%, specificity of 85.0%, and accuracy of 87.3% (κ = 0.75). For CSI diagnosis, IV-CEUS had a sensitivity of 69.2%, specificity of 93.1%, an accuracy of 88.7% (κ = 0.62), while MRI had a sensitivity of 76.9%, specificity of 87.9%, and accuracy of 85.9% (κ = 0.60). The areas under the curves (AUCs) were 0.704 (95% CI: 0.584-0.824) for IV-CEUS and 0.718 (95% CI: 0.602-0.834) for MRI in diagnosing DMI; and those were 0.852 (95% CI: 0.743-0.961) for IV-CEUS and 0.838 (95% CI: 0.721-0.955) for MRI in diagnosing CSI. CONCLUSION: IV-CEUS demonstrates comparable diagnostic performance to MRI in assessing DMI and CSI in EC patients. It may serve as a viable alternative when MRI is contraindicated or unavailable.