Imaging in gynecological disease

From its conception, this Journal has aimed at publishing high-quality papers in the fields of obstetric and gynecological ultrasound. The founding editor, Prof. Stuart Campbell, was a pioneer in both disciplines, but few specialists nowadays practice at an advanced level in both fields. Historically, ultrasound was developed to visualize the fetus, while gynecological ultrasound became popular only after the introduction of the transvaginal probe in the early 1980s. As a result, while many specialists do use ultrasound in gynecology, it is generally used far less in gynecology than in obstetrics, which may explain why relatively few specialists fully master gynecological ultrasound, and why the amount of research performed in this area is behind that in obstetric ultrasound. A quick look at the contents of this Journal reveals that far more papers are published in obstetrics than in gynecology, despite the acceptance rate being similar for obstetric and gynecological manuscripts submitted to the Journal. Moreover, fewer gynecological abstracts than obstetric abstracts are submitted to the ISUOG World Congress. However, over the last few years the field of gynecological ultrasound has been evolving quickly, and increasingly, specialists are discovering the value of high-level gynecological ultrasound. Using ultrasound, gynecologists can assess and manage patients with early pregnancy complications (miscarriage, ectopic pregnancies), pain, pelvic infections and abnormal bleeding much more efficiently than they can without it, and in many cases diagnostic and therapeutic procedures that are less invasive can be offered1–7. Gynecological ultrasound can be used for preoperative diagnosis8–13 and staging14–17 of gynecological cancer. Pelvic recurrences of malignancies can be diagnosed effectively with ultrasound18–22. In the management of patients with subfertility, ultrasound has become pivotal in both diagnosis and treatment23–25. More recently, assessment of the pelvic floor with ultrasound has been introduced into urogynecology26–28. Although gynecologists are using ultrasound increasingly in their daily practice, unlike obstetric ultrasound, where guidelines and certificates issued by bodies such as The Fetal Medicine Foundation are well established, it is not always practiced at a high level. Unfortunately, while high-quality ultrasound can be beneficial, low quality ultrasound may harm29; therefore it is necessary to devote more time and effort to education in gynecological ultrasound both at the ISUOG World Congress and in our Journal. For this reason, a new series of papers under the banner ‘Imaging in Gynecological Disease’ is planned for the Journal. The articles in the series, the first of which is published in this issue30, will present original peer-reviewed imaging data on the typical ultrasound findings of specific gynecological conditions and will be supplemented by a broader educational component. They will have a common format, with a structured abstract, followed by background information from the literature summarized according to epidemiology, macroscopic and microscopic appearances, clinical symptoms and prognosis. The methods section will describe how data were collected, then results will be presented, and finally a discussion will highlight the existing and new information on imaging features of rare gynecological diseases. The broader term ‘imaging’ has been chosen because imaging techniques other than ultrasound, which might provide complementary information in some cases, may be discussed as well. We hope that this initiative will promote both research and education in imaging in gynecology.