Murat Osman

Senior Research Columnist: Murat Osman is a MD candidate at The George Washington University School of Medicine and Health Sciences. His interest in research is primarily focused on Medical Oncology and Radiology. He is also focused on cultivating his passion for medical science and human health through scientific writing and advocacy.

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…

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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.…

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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,…

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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…

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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…

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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…

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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…

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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…

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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…

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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…

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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…

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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"…

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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…

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Endometriosis involving the superficial peritoneum in Adolescents: Surgical Management

Endometriosis is a chronic disease whereby endometrial glands and stroma grow and survive outside of the uterus. In some cases, endometriosis may become symptomatic and cause debilitating, chronic pelvic pain. Among pelvic organ and other surfaces that endometriosis can involve is the peritoneum. The peritoneum is a connective Endometriosis that affects adolescent girls typically presents as Stage I with superficial peritoneal disease (SPD) and less commonly as Stage III or IV with deeply infiltrating endometriosis (DIE). A 15-year-old adolescent female…

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The duration of impairment of ovarian reserve after laparoscopic surgery

Endometriosis is a chronic medical condition characterized by ectopic endometrial tissue that grows and invades extra-uterine tissues. It is a significant contributor to chronic pelvic pain in women of reproductive age. Endometriosis involving the ovaries and causing a cystic growth is called an "endometrioma". Laparoscopic ovarian cystectomy (LOC) for endometriomas has been widely used but may be associated with decreased ovarian reserve. Several hormonal markers including anti-mullerian hormone (AMH) have been used to assess ovarian reserve. In the present study,…

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Priorities and Unmet Needs of Endometriosis Management

Endometriosis is a systemic, chronic disease that is a significant contributor to morbidity in young women. Although endometriosis has gained increasing attention in the medical field, scientific progress for an effective and definitive treatment modality is progressing slowly. The Society for Women’s Health Research (SWHR), a non-profit organization, aimed to aid the current understanding of this disease, has designed a roundtable meeting to review both the diagnostics and treatment of endometriosis. An interdisciplinary dialogue between researchers, clinicians, patients, industry, and…

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Signs and Symptoms on Transvaginal Ultrasound associated with the presence of endometriosis.

Endometriosis is a disease whereby ectopic endometrial cells are present outside of the uterus. Transvaginal ultrasound (TVUS) is a highly specific test for endometriomas and deep endometriosis to assess the involvement of endometriosis in the posterior anatomic compartments. While the diagnosis of these involved areas can be performed using ultrasonography, the gold standard continues to be surgery and histopathologic confirmation especially for the diagnosis of superficial endometriosis. This study conducted by Reid et al. from several institutions in Sydney, Australia…

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Development of Less Invasive Diagnostic Tests for Endometriosis Through Proteomics

Proteomics is a field which utilizes various methods to carry out large-scale studies of proteins. Due to the inherent nature of the field, proteomics focuses on the identification, localization, and functional analysis of the protein make-up of a given type of cell. Understanding different proteins and their function, expression, and structure allow researchers to understand complex disease processes and identify new drug targets that may be useful in the clinical setting for individuals who suffer from endometriosis. Currently, the gold…

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Lipophilic Statins inhibit growth and invasiveness of human endometrial cells

Endometriosis is a disease process whereby cells of the endometrium grow and invade structures outside of the uterus. Through recent research, it has been seen that endometriotic foci in women with endometriosis exhibit an altered phenotype that contributes to its invasiveness and abnormal proliferation. Thus, understanding the interaction of potential medications to slow or halt the progression of endometriosis would allow for more targeted therapies to be developed. Statins are a class of HMG-CoA reductase inhibitors widely used today as…

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Laparoscopic mesenteric vascular and nerve sparing surgery as a tool for DIE resection

Endometriosis can be characterized by a wide range of clinical aggressiveness based upon the location, character, and growth of ectopic endometrial implants. As one of the most aggressive forms of endometriosis, deep infiltrating endometriosis (DIE) is known to involve the colon and bladder. Surgery in these patients may lead to complications such as urinary retention, constipation and sexual dysfunction. Surgical techniques aimed at minimizing these complications are being developed such as pelvic nerve-sparing surgery.  The researchers from the Department of…

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