Alcazar JL, Pich Barroso DM, Sanchez O, Brunel I, Vilches JC, Orozco R. Enhanced detection of vascularization in rectal endometriosis: A comparative study of microvascular flow and power Doppler. World J Radiol 2026; 18(5): 119223 [DOI: 10.4329/wjr.v18.i5.119223]
Corresponding Author of This Article
Juan Luis Alcazar, MD, PhD, Department of Obstetrics and Gynecology, Hospital Quirónsalud Málaga, Avenida Pilar Lorengar 1, Málaga 29004, Andalusia, Spain. jlalcazar@unav.es
Research Domain of This Article
Obstetrics & Gynecology
Article-Type of This Article
Prospective Study
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Alcazar JL, Pich Barroso DM, Sanchez O, Brunel I, Vilches JC, Orozco R. Enhanced detection of vascularization in rectal endometriosis: A comparative study of microvascular flow and power Doppler. World J Radiol 2026; 18(5): 119223 [DOI: 10.4329/wjr.v18.i5.119223]
World J Radiol. May 28, 2026; 18(5): 119223 Published online May 28, 2026. doi: 10.4329/wjr.v18.i5.119223
Enhanced detection of vascularization in rectal endometriosis: A comparative study of microvascular flow and power Doppler
Rodrigo Orozco, Jose Carlos Vilches, Ignacio Brunel, Oscar Sanchez, Diego Maria Pich Barroso, Juan Luis Alcazar
Juan Luis Alcazar, Ignacio Brunel, Jose Carlos Vilches, Rodrigo Orozco, Department of Obstetrics and Gynecology, Hospital Quirónsalud Málaga, Málaga 29004, Andalusia, Spain
Juan Luis Alcazar, Department of Obstetrics and Gynecology, University of Navarre, Pamplona 31008, Navarre, Spain
Diego Maria Pich Barroso, Department of Obstetrics and Gynecology, Hospital Universitario Rio Hortega, Valladolid 47012, Castille-Leon, Spain
Oscar Sanchez, Department of Obstetrics and Gynecology, Hospital Universitari Arnau de Vilanova, Lleida 25198, Catalonia, Spain
Author contributions: Alcazar JL, Pich Barroso DM, Sanchez O, Brunel I, Vilches JC, and Orozco R contributed to draft reviewing; Alcazar JL, Pich Barroso DM, and Sanchez O contributed to investigation; Alcazar JL and Orozco R contributed to draft writing; Alcazar JL contributed to conceptualization. All authors approval the final manuscript.
Institutional review board statement: This retrospective study was waived by the Ethics Committee of Hospital Quirónsalud Málaga. This study does imply only routine procedures performed in patients presenting for endometriosis evaluation.
Clinical trial registration statement: This study was not registered because this is an exploratory pilot study addressing a proof-of-concept.
Informed consent statement: All women participating in this study gave oral informed consent after the nature of the study was fully explained. No written informed consent was required since all examinations performed were done as part of routine evaluation within their clinical context (transvaginal ultrasound).
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: Data are available from the authors upon reasonable request.
Corresponding author: Juan Luis Alcazar, MD, PhD, Department of Obstetrics and Gynecology, Hospital Quirónsalud Málaga, Avenida Pilar Lorengar 1, Málaga 29004, Andalusia, Spain. jlalcazar@unav.es
Received: January 29, 2026 Revised: March 4, 2026 Accepted: April 3, 2026 Published online: May 28, 2026 Processing time: 123 Days and 15.4 Hours
Abstract
BACKGROUND
Conventionally, rectal endometriotic nodules have been considered as poorly vascularized. However, new, more sensitive, Doppler techniques have been developed recently for assessing microvascularization. These new techniques might allow microvascularity in these lesions.
AIM
To compare the vascularization of rectal endometriotic nodules using microvascular (MV) flow and conventional power Doppler.
METHODS
Thirty consecutive women diagnosed with deep endometriosis involving the rectum were recruited for this prospective study. All women underwent transvaginal ultrasound using a Samsung V8 ultrasound system (Samsung Medison, Co., Ltd., Seoul, South Korea). The scanning protocol was performed according to the International Deep Endometriosis Analysis consensus. Endometriotic lesions involving the rectum were identified as hypoechoic lesions with blurred margins. Then, power Doppler was activated and the vascularization of the lesion was assessed. Immediately after, the MV-Flow™ with the LumiFlow™ was activated and the vascularization was assessed again. Vascularization assessment was undertaken based on the subjective examiner’s impression, using the vascular score proposed by International Ovarian Tumor Analysis group.
RESULTS
The vascular score using conventional power Doppler was score 1 in 87% (n = 26) and score 2 in 13% (n = 4) of the lesions, respectively. The vascular score using MV-Flow™ was score 1 in 6% (n = 2), score 2 in 27% (n = 8), score 3 in 40% (n = 12) and score 4 in 27% (n = 8) of the cases. Grouping cases into score 1-2 vs score 3-4, there was a statistically significant difference with score 3-4 when using MV-Flow™ (67% vs 0%, P < 0.01).
CONCLUSION
This study shows that many rectal endometriotic nodules exhibit more vascularization than previously thought when using MV-Flow™.
Core Tip: Rectal endometriotic nodules as assessed by microvascular flow exhibit more vascularization than previously thought. This finding is a changing paradigm observation and it opens new research fields, such as the assessment of vascularization of rectal endometriotic nodule vascularization for predicting disease evolution, response to medical therapy or risk of recurrence after surgery.
