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Related Experiment Video

Updated: May 19, 2026

Intraoperative Detection of Subtle Endometriosis: A Novel Paradigm for Detection and Treatment of Pelvic Pain Associated with the Loss of Peritoneal Integrity
07:20

Intraoperative Detection of Subtle Endometriosis: A Novel Paradigm for Detection and Treatment of Pelvic Pain Associated with the Loss of Peritoneal Integrity

Published on: December 21, 2012

Tissue characterization using mean gray value analysis in deep infiltrating endometriosis.

S Guerriero1, M Pilloni, J L Alcazar

  • 1Department of Obstetrics and Gynaecology, Azienda Ospedaliero Universitaria di Cagliari, Cagliari, Italy.

Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology
|August 24, 2012
PubMed
Summary

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Deep endometriosis nodules in the rectosigmoid have higher mean gray values (MGV) than retrocervical nodules. This ultrasound measurement is reproducible and may aid in diagnosing deep endometriosis distribution.

Area of Science:

  • Medical imaging
  • Gynecologic oncology
  • Ultrasound tissue characterization

Background:

  • Deeply infiltrating endometriosis (DIE) affects various pelvic locations.
  • Accurate tissue characterization is crucial for diagnosing and managing DIE.
  • Ultrasound-based quantitative metrics like mean gray value (MGV) show promise for DIE assessment.

Purpose of the Study:

  • To compare the sonographic mean gray value (MGV) of retrocervical and rectosigmoid deeply infiltrating endometriosis.
  • To evaluate the intra- and interobserver reproducibility of MGV measurements in DIE nodules.

Main Methods:

  • Retrospective analysis of 57 DIE nodules from 50 women using stored ultrasound volumes.
  • MGV quantification using virtual organ computer-aided analysis (VOCAL) software with semiautomated sphere-sampling.

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Last Updated: May 19, 2026

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  • Comparison of MGV between retrocervical and rectosigmoid DIE, and with uterine myometrium. Inter- and intraobserver agreement assessed using intraclass correlation coefficients (ICC).

    • Main Results:

    • Rectosigmoid DIE nodules exhibited significantly higher MGV than retrocervical nodules (23.863 vs. 17.705, P < 0.001).
    • Myometrial MGV was significantly higher than that of DIE nodules in both locations (P < 0.001).
    • Excellent intra- and interobserver reproducibility was observed (ICC > 0.95).

    Conclusions:

    • Significant differences in MGV exist between retrocervical and rectosigmoid DIE.
    • MGV measurement demonstrates high reproducibility.
    • Further studies are warranted to assess the clinical utility of MGV in diagnosing and assessing the distribution of deep endometriosis.