How accurate is MRI vs expert transvaginal ultrasound for endometriosis?

For deep infiltrating endometriosis and ovarian endometriomas, MRI and expert transvaginal ultrasound tend to have similarly high accuracy, and the “best” test often depends on what we’re looking for and where. MRI is generally less operator-dependent and can be especially helpful for broader, multi-compartment pelvic mapping, while a highly skilled ultrasound exam can be excellent for targeted evaluation of specific structures.

It’s also important to know the shared limitation: both MRI and ultrasound can miss superficial peritoneal endometriosis, so normal imaging does not necessarily rule out endometriosis. If your symptoms persist despite reassuring scans, our team can review your imaging and history together and discuss what the next step in evaluation and treatment should be, including whether surgery is appropriate.