Delayed Diagnosis of Endometriosis and New Imaging Advances
For many women, obtaining a diagnosis of endometriosis can take several years. A pilot study conducted at Oxford University indicates that a novel scanning method might enable earlier detection of the condition.
This approach combines CT scans with a molecular tracer to identify early-stage endometriosis, which conventional imaging often fails to detect.
If validated through larger studies, this technique could provide women with earlier explanations for their symptoms, according to researchers.
Endometriosis affects approximately one in ten women in the UK. It is a painful disorder characterized by cells resembling those lining the womb growing outside the uterus. On average, diagnosis takes nine years.
Symptoms vary widely and can be severe, including heavy menstrual bleeding, extreme fatigue, and abdominal pain, often resembling other medical conditions.
Patients frequently undergo multiple diagnostic tests such as ultrasounds and occasionally MRI scans.
However, standard imaging often misses the disease, primarily detecting changes associated with more advanced stages, explains Dr Tatjana Gibbons, the study's lead researcher.
"This means many struggle with symptoms, despite being told they have normal imaging results. Getting a diagnosis earlier can help people make decisions and plans about their life," Dr Gibbons adds.
'A very long journey'
Gabriella Pearson, co-founder of the Menstrual Health Project charity, was diagnosed with endometriosis at age 23 after enduring over a decade of worsening symptoms and multiple misdiagnoses.
The 33-year-old reflects that earlier listening and diagnosis would have placed her in a very different situation today.
Endometriosis has affected her bowel, bladder, and ovary, resulting in lasting damage.
"Because of the pain and the complications I wasn't able to progress with my career and go to university," Pearson states.
"There is a knock-on effect in terms of mental health, finances, work and fertility. So I think if people are diagnosed earlier and have a better chance of prolonged quality of life at a younger age, it could really help."
Pearson began experiencing debilitating menstrual pain at age 10, which left her in severe agony.
Over time, she developed painful digestive issues triggered by food intake.
Initially, her symptoms were dismissed as "part of being a woman," later attributed to irritable bowel syndrome or stress.
She consulted doctors repeatedly for six years before a general practitioner suggested endometriosis as a likely diagnosis.
"It has been a very long journey and we definitely need more accuracy when it comes to scans," Pearson says.
"We deserve something that is more consistent and reliable for patients and is non-invasive as well. For me, I really struggled with an invasive ultrasound, which was very painful."
Her ultrasound results were interpreted differently by various doctors.
Years later, she underwent laparoscopy surgery to obtain a definitive diagnosis, feeling it was necessary to understand her condition fully.
New findings 'really exciting'
While some treatments can be offered without a definitive diagnosis, currently the only conclusive method is laparoscopy, involving insertion of a small camera through an abdominal incision, a procedure that can take years to be scheduled.
In the study, 19 individuals with confirmed or suspected endometriosis underwent CT scans combined with an injection of a molecular tracer named maraciclatide. This tracer binds to areas where new blood vessels form, believed to be crucial in early endometriosis development.
The technique accurately identified the presence or absence of endometriosis in 16 participants.
It correctly detected 14 of 17 cases later confirmed by surgery.
Dr Gibbons describes the results as "exciting."
"The technique offers a highly promising diagnostic and monitoring tool, particularly for superficial peritoneal endometriosis [thought to be an early form of the disease] which is the most common and yet the hardest type of endometriosis to identify."
Dr Lucy Whitaker, a gynaecologist and researcher at the University of Edinburgh not involved in the study, notes the urgent need for new non-invasive imaging methods.
"This is a really exciting preliminary data that needs further studies," she says. "If confirmed, that gives us a real opportunity to intervene at an earlier stage - and help people get a diagnosis and potentially consider treatment earlier on."
The new technique may also assist in monitoring disease progression and evaluating treatment efficacy.
Dr Whitaker adds that the scans and tracer involve radiation exposure, which requires careful consideration relative to the risks of laparoscopy.
The research is published in the journal Lancet Obstetrics, Gynaecology and Women's Health and was led by the Nuffield Department of Women's and Reproductive Health at the University of Oxford in collaboration with Serac Healthcare.
Symptoms to watch out for:
Additional reporting by Vicki Loader
