Murat Osman

Senior Research Columnist: Murat Osman is a PGY-1 Interventional Radiology resident at Rush University Hospital in Chicago, IL. His interests include imaging techniques and findings used for endometriosis detection as well as interventional procedures for female and male reproductive health. His articles aim to cultivate his passion for medical science and human health through scientific writing and advocacy so that anyone can learn from newly released research literature.

Diagnosing Deep Endometriosis Using Transvaginal Elastosonography

Deeply infiltrating endometriosis (DIE) is an advanced form of endometriosis that causes significant morbidity to a large number of women. Early detection of endometriosis is imperative for early treatment and improved outcomes for these patients. Currently, transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI) are two of the main imaging modalities used to diagnosis DIE. Due to its lower cost and ease of use, TVUS is usually the first-line imaging modality in the work-up of women with pelvic pain and suspected…

Key Points Lay Summary

East/South East Asian Ethnicity and Moderate-to-Severe Endometriosis

Endometriosis is a chronic inflammatory disease that is defined by the presence of ectopic endometrial tissue outside of the uterus. Understanding how this disease affects diverse groups of people will aid doctors in assessing and diagnosing populations that are high-risk for advanced endometriosis. This article titled, “East/South East Asian Ethnicity and Moderate-to-Severe endometriosis” published in The Journal of Minimally Invasive Gynecology by Williams et al. from institutions in British Columbia and Alberta, Canada aims to investigate the ethnic differences for…

Key Points Lay Summary

Ultrasound diagnosis of endometriosis: One Size Does-Not-Fit-All

Deeply infiltrating endometriosis (DIE) is an advanced form of endometriosis that causes significant morbidity to many women. The Pouch of Douglas (POD), otherwise known as the rectouterine space, is the anatomic area between the posterior cervix and anterior rectum. Its obliteration on ultrasound (loss of this anatomic space due to fibrosis) has been used as a marker for endometriosis involvement of the bowel. The assessment of endometriosis on transvaginal ultrasound (TVUS) is technically challenging and due to the clinical heterogeneity…

Key Points Lay Summary

Improved fusion imaging for the detection of Endometriosis

This paper studied a new fusion method for magnetic resonance (MR) and ultrasound (US) imaging for the appropriate diagnosis of endometriosis. The diagnosis of endometriosis in patients with a chronic pelvic disease is delayed, due to the disease, patient, and physician-led factors. A recent active study area is how ordering physicians can work together to diagnosis endometriosis earliest possible. However possible screening and imaging methods are still not the best by the fact that the heterogeneous nature of the endometriosis. Although laparoscopy…

Key Points Lay Summary

How should MRI images be obtained for optimal endometriosis detection?

It is well known that the diagnosis of endometriosis for some patients with the chronic pelvic disease is delayed, often for years, due to the disease, patient, and physician-led factors. An area of active study is how ordering physicians can work together to diagnosis endometriosis as early as possible. Discussions on possible screening recommendations and imaging protocols are made more difficult by the fact that endometriosis is a very heterogeneous disease with three main clinical manifestations; ovarian endometriomas, deeply infiltrating…

Key Points Lay Summary

Imaging of gastrointestinal endometriosis

Endometriosis is a disease characterized by the ectopic implantation of endometrial tissue to surrounding pelvic and extra-pelvic structures. One frequent site of involvement is the gastrointestinal(GI) tract, which occurs especially among women with deep infiltrating endometriosis. Most cases of GI-involving endometriosis are found around the rectosigmoid colon, up to 90%; however other sites have also been seen. While histopathologic confirmation after surgical sampling remains the gold standard, ultrasound and magnetic resonance imaging are increasingly being used for screening due to…

Key Points Lay Summary

Abdominal wall endometriosis: Who is at risk and what causes it?

Endometriosis is a condition that can cause anatomic, hormonal, and inflammatory disturbances that may ultimately result in decreased fertility or infertility. It is a disease process that is defined as ectopic endometrial-like tissue implanting itself to various pelvic and extra pelvic organs. One area that can be involved, is the inner surface of the abdominal wall, known as abdominal wall endometriosis. This rather uncommon presentation of endometriosis has a reported incidence of 0.03 to 3.5%, with most cases associated with…

Key Points Lay Summary

Current Status of Transvaginal Ultrasound Accuracy in the Diagnosis of Deep Infiltrating Endometriosis

Transvaginal ultrasound (TVUS) is an imaging tool that is irreplaceable for the diagnosis of multiple gynecologic conditions such as ovarian torsion, ectopic pregnancy, and uterine leiomyomas. TVUS is increasingly being used in the diagnosis of endometriosis as it can assess the presence of endometriosis in not only the uterus and ovaries but also in deeper pelvic structures. Due to its increasing use, the question remains as to whether TVUS is as accurate in the diagnosis of DIE as other imaging…

Key Points Lay Summary

Which treatment option improves fertility the most?

Endometriosis is a condition that causes anatomic, hormonal, and inflammatory disturbances that may ultimately result in decreased fertility or infertility. It is estimated that 30-50% of women with endometriosis suffer from infertility. Thus, the role of surgical, medical, or expectant management for patients with varying severity of endometriosis should be an active subject of research. Unfortunately, definitive data from randomized-control studies comparing surgical, medical, and expectant management in women who wish to have the greatest chance of conceiving is lacking.…

Key Points Lay Summary

Worrying signs of Endometriosis on Hysterosalpingography

Hysterosalpingography (HSG) is an imaging modality that utilizes fluoroscopy in order to evaluate the uterine cavity, fallopian tubes, and adjacent peritoneal cavity by injecting contrast media through the cervical canal. It is an important tool in the work-up of patients who present with infertility. Thus, radiologists performing and interpreting HSG should be familiar with the findings suspicious for endometriosis-associated infertility in this patient population. A recent article titled, “Hysterosalpingography in endometriosis: performance and interpretation” by Kilcoyne et al. in Abdominal Radiology,…

Key Points Lay Summary

The Molecular Profile Unique to Endometriosis

Endometriosis remains to be a disease entity that is not fully understood. However, recent studies suggest that endometriosis is characterized by several dysregulated biochemical pathways that allow for its survival and growth outside the uterine endometrium. Authors have recently published an original study that aims to analyze the molecular profile of endometriosis using mass spectrometry (MS) and ionization analysis techniques (DESI). It is through this technology that researchers aim to investigate the molecular alterations of endometriosis in the hopes of…

Key Points Lay Summary

Post-menopausal women diagnosed with Endometriosis and "Imaging"

Postmenopausal endometriosis is an underrecognized clinical entity that may present similarly to those of younger patients with endometriosis. Radiologists have an important role in the diagnosis of these patients as they recommend which imaging study should be used to differentiate endometriosis from other possible entities. Authors from the Department of Radiology and Obstetrics and Gynecology at Mayo Clinic recently wrote an article titled, “Endometriosis in the postmenopausal female: clinical presentation, imaging features, and management” in the Journal of Abdominal Radiology in order to…

Key Points Lay Summary

Heterogeneity of Endometriosis

As the scientific community becomes more aware of the genetic, clinical, and biochemical complexity of endometriosis, so too does the statistical analysis behind the formulation of evidence-based medicine for its treatment. Endometriosis has more recently been found to be a macroscopically heterogeneous disease that has a wide variety of clinical presentations and behaviors. For example, it has been recently found that some deep endometriosis lesions have cancer-associated driver mutations. While most endometriosis lesions require estrogen to progress, in some cases…

Key Points Lay Summary

Transvaginal Ultrasound of Endometriosis

A recent manuscript published by Collins et al. from the Department of Radiology at Penn State Hershey Medical Center aims to review the transvaginal ultrasound (TVUS) evaluation of endometriosis and offer a protocol that is dedicated to the thorough evaluation of women suspected to have endometriosis. The International Deep Endometriosis Analysis (IDEA) Consensus Group, a panel of experts convened to standardize US assessment of endometriosis have recently agreed that routine pelvic US protocols are not enough to evaluate all the…

Key Points Lay Summary

Nanotechnology as a tool for targeted therapy of endometriosis

Endometriosis is a process whereby endometrial cells persistently grow and invade extra-uterine tissue through a primarily estrogen-dependent manner. These ectopic endometrial cells proliferate in sometimes an uncontrolled manner, similar to cancer or inflammatory tissues. To proliferate, cells need cholesterol to build their outside membranes. Low-density lipoprotein is one such cholesterol that is needed.  Authors, Bedin et al. aim to utilize this phenomenon by administering nanoparticles that are similar in structure to low-density lipoprotein (LDE), to assess if endometriosis cells take up…

Key Points Lay Summary

Endometriosis that involves the nerves: how Radiologists can help

Endometriosis is a disease with variable clinical symptoms. While rare, nerve involvement by endometriosis may cause neurologic symptoms such as pelvic pain, muscle weakness, bowel and bladder incontinence, and paraplegia depending on the specific nerve involved. Thus, abdominal radiologists should assess pelvic nerve anatomy especially on pelvic MRI and the possible patterns of presentation in patients with nerve-involving endometriosis in order to prevent permanent nerve damage. Therefore, early diagnosis of this rare disease manifestation cannot be overlooked. In this pictorial essay…

Key Points Lay Summary

Transvaginal Ultrasound and the Imaging of Endometriosis

Ultrasonography (US) is an imaging tool that uses sound waves to produce a two-dimensional picture inside of the body. The ultrasonography has become especially useful in the assessment of gynecologic pathologies such as endometriosis. Depending on the severity of endometriosis, various intra and extra-pelvic locations may be involved. One such category of endometriosis is deep endometriosis, which is characterized by the involvement of the posterior pelvic structures such the uterosacral ligaments, structures which attach the posterior aspect of the uterus…

Key Points Lay Summary

ENDORECT scoring system to identify patients at risk for rectosigmoid endometriosis

Patients who suffer from endometriosis may benefit from a preoperative score that predicts rectosigmoid involvement. A recent paper published by Huchon et al. at Poissy Saint-Germain en Laye, France, recruited 119 women who underwent laparoscopy for endometriosis between 2011 and 2016 with histologic verification. RE involvement was defined as one or more nodules infiltrating the muscle layer of the intestinal wall during complete excisional surgery. Of the 119 women, 47 had RE involvement while 72 did not. Of the patients…

Key Points Lay Summary

MRI-based "ENZIAN" scoring system and intra-operative endometriosis findings

Endometriosis is a chronic inflammatory disease whereby endometrial-like glands grow and invade the extra-uterine structures. Endometriosis may affect various parts of the body, including the peritoneum, ovaries, or retroperitoneum. Recently, non-invasive methods for detecting these lesions have included trans-vaginal ultrasound (TVUS) and magnetic resonance imaging (MRI) for pre-operative planning of patients undergoing surgery. However, compared to the gold standard of diagnostic laparoscopy, these imaging methods have not been found to outcompete laparoscopy in terms of sensitivity and sensitivity. The "ENZIAN"…

Key Points Lay Summary

A guide on the Assessment of Pelvic Endometriosis Imaging

Endometriosis is a disease whereby ectopic endometrial-like tissue invades and survives outside of the endometrial cavity. While biopsy-proven confirmation of endometriosis during laparoscopy has been considered the gold standard for diagnosis, non-invasive imaging modalities are increasingly being utilized for preoperative planning. A multicenter group of clinicians, surgeons, and radiologists from Sao Paulo, Brazil, the Mayo Clinic, Arizona, and the Cleveland Clinic, Ohio, published an article in The Journal of Minimally Invasive Gynecology in order to highlight the radiologic characteristics, advantages/disadvantages, and…

Key Points Lay Summary