This review looks at highlights of the development in ultrasound, ranging from interventional ultrasound and Doppler to the newest techniques like contrast-enhanced ultrasound and elastography, and gives reference to some of the valuable articles in Acta Radiologica. Ultrasound equipment is now available in any size and for any purpose, ranging from handheld devices to high-end devices, and the scientific societies include ultrasound professionals of all disciplines publishing guidelines and recommendations. Interventional ultrasound is expanding the field of use of ultrasound-guided interventions into nearly all specialties of medicine, from ultrasound guidance in minimally invasive robotic procedures to simple ultrasound-guided punctures performed by general practitioners. Each medical specialty is urged to define minimum requirements for equipment, education, training, and maintenance of skills, also for medical students. The clinical application of contrast-enhanced ultrasound and elastography is a topic often seen in current research settings.

Ultrasound is an undervalued non-invasive examination in the diagnosis of colonic diseases. It has been replaced by the considerably more expensive magnetic resonance imaging and computed tomography, despite the fact that, as first examination, it can usefully supplement the diagnostic process. Transabdominal ultrasound can provide quick information about bowel status and help in the choice of adequate further examinations and treatment. Ultrasonography, as a screening imaging modality in asymptomatic patients can identify several colonic diseases such as diverticulosis, inflammatory bowel disease or cancer. In addition, it is widely available, cheap, non-invasive technique without the use of ionizing radiation, therefore it is safe to use in childhood or during pregnancy, and can be repeated at any time. New ultrasound techniques such as elastography, contrast enhanced and Doppler ultrasound, mini-probes rectal and transperineal ultrasonography have broadened the indication. It gives an overview of the methodology of various ultrasound examinations, presents the morphology of normal bowel wall and the typical changes in different colonic diseases. We will pay particular attention to rectal and transperineal ultrasound because of their outstanding significance in the diagnosis of rectal and perineal disorders. This article seeks to overview the diagnostic impact and correct indications of bowel ultrasound.

OBJECTIVE: Rectovaginal endometriosis has the potential to infiltrate into the rectal wall. The recognition of infiltration prior to surgery is of utmost importance since only infiltrative disease should be treated by partial or complete rectal resection. This study compares different imaging procedures in rectovaginal endometriosis cases in an everyday clinical setting.
METHODS: Seventy nine consecutive women diagnosed with rectovaginal endometriosis were included in this prospective study. Preoperatively, all women had a rectovaginal gynaecological examination and transvaginal sonography. Furthermore, MRI or rectal endosonography imaging procedures together with a rectosigmoidoscopy and estimation of a serum Ca125 were undertaken. Sensitivity and specificity of all diagnostic tools were compared with the intraoperative findings.
RESULTS: The procedure with the highest accuracy was bimanual rectovaginal gynaecological examination (sensitivity: 0.92/specificity: 0.32). Rectal endosonography obtained a sensitivity of 0.44 and a specificity of 0.77. All other diagnostic procedures such as Ca125 (sensitivity: 0.42/specificity: 0.81), MRI (sensitivity: 0.41/specificity: 0.83), transvaginal sonography (sensitivity: 0.2/ specificity: 0.79) and rectosigmoidoscopy (sensitivity: 0.03/specificity: 0.92) were only of limited value.
CONCLUSIONS: The diagnostic method with the highest sensitivity to detect bowel infiltration in an everyday clinical setting is the gynaecological examination. It is followed by rectal endosonography. However, none of the currently available preoperative diagnostic tools can predict infiltrative growth of rectovaginal endometriosis with any certainty. Hence, infiltrative growth still needs to be verified by operative assessment.