Novasono Ultrasound - Clinical Innovator Articles in Endometriosis

Clinical Innovator. ORIGINAL SYNTHESIS. UROGYNECOLOGY

Clinical Innovator articles: Endometriosis. Original Synthesis from the Novasono Corporation Research Programme

A curated library of original clinical articles on endometriosis ultrasound, developed to extend the reference framework of the Advanced Ultrasound Mapping (AUM) tier examination — from the foundational IDEA-protocol examination through the seven coordinated AUM modalities, the #ENZIAN(u) structured reporting system, the comorbid imaging targets, and the proposed NEPI multidimensional classification.

AUTHORS Isac Cabrera & Tatiana Pupo. INSTITUTION Miami Sonogram, Novasono Corporation ISSUE May 2026

Articles under revision.

THE THE INTEGRATED AUM FRAMEWORK

A Structured Architecture in Three Layers

Each article of this series builds on the foundational work of Guerriero, Condous, Hudelist, Keckstein, Van den Bosch, and the broader endometriosis imaging community. Our contribution is methodological: to extend the IDEA-protocol anatomical floor of pelvic superficial and deep endometriosis assessment from categorical morphological description into an integrated multimodal, multidimensional framework that contemporary imaging and classification methodology supports.

The twelve-modality AUM architecture and the nine-component NEPI classification are presented as proposed frameworks for the clinical research community. The individual component markers, the categorical composite, and the operational decision instrument each require prospective validation before clinical deployment.

I Seven Coordinated AUM Modalities

Modified office gel sonovaginography, dynamic sliding sign, tenderness-guided imaging, strain and shear-wave elastography, microvascular flow imaging, and extrapelvic / neuropelvic mapping — each addressing a specific anatomical, functional, or biological limitation of the foundational IDEA examination, reported alongside the structured IDEA-protocol findings.

II ENZIAN(u) Structured Reporting and Comorbid Imaging Targets

The 2021 revised #ENZIAN classification with the (u) ultrasound suffix provides the standardized compartmental output language of the AUM examination, with the comorbid imaging targets — adenomyosis (MUSA 2022), endometriomas with ovarian reserve assessment, and pelvic floor coupling — integrated into the structured documentation alongside the deep endometriosis findings.

III. NEPI Multidimensional Classification

The proposed Novasono Endometriosis Phenotypic Index, integrating nine component markers (ABS, SPE, LBI, SDQ, AMC, TID, PFC, OVR, TPS) into a five-band BI-RADS-analogue categorical summary and the four-component NEDS operational decision instrument, with the pre-IVF mapping context as one of the principal clinical application domains.

THE COMPLETE LIBRARY

All Clinical Innovator Articles. Endometriosis Mapping.

00 SERIES INTRODUCTION. APU PARADIGM

The APU Paradigm: Two-Tier SRU Framework for Endometriosis Ultrasound

Introductory commentary establishing the two-tier framework (Adequate Pelvic Ultrasound + Advanced Ultrasound Mapping) of the SRU 2024 consensus and situating the seven coordinated AUM modalities within the contemporary published evidence on structured endometriosis imaging. Read...

01 AUM MODALITY · GEL SONOVAGINOGRAPHY

Modified Office Gel Sonovaginography

The acoustic-window modality that resolves the principal IDEA-protocol limitation in posterior compartment visualisation — anchored on the Reid 2014 sensitivity 86% / specificity 93% evidence and operationalised into a structured ten-target documentation protocol. Read...

02 AUM MODALITY · DYNAMIC FUNCTIONAL

The Dynamic Sliding Sign

The functional modality assessing pouch of Douglas obliteration through structured dynamic imaging — built on the Reid 2013 and Hudelist 2013 foundations and the Gerges 2022 meta-analytic AUC 0.97, with the proposed three-site Sliding Dynamic Quotient (SDQ) framework extending the binary sliding sign into a graded assessment. Read...

03 AUM MODALITY · SYMPTOMATIC CORRELATION

Tenderness-Guided Imaging

The symptomatic-territory modality correlating the tenderness map with the anatomical findings — building on the Guerriero 2008 and Reid 2019 foundations and the McClenahan 2026 cohort, with the proposed seven-site Tenderness Pattern Signature (TPS) supporting structured documentation of the symptomatic-anatomical correlation. Read...

04 AUM MODALITY · TISSUE STIFFNESS

Strain and Shear-Wave Elastography

The biological characterization modality assessing lesion stiffness as a marker of activity versus fibrotic maturity — anchored on the Takeuchi 2024 sensitivity 97.8% / specificity 100% findings, the Schiffmann 2014 foundation, and the Stoelinga 2023 adenomyosis application, with the proposed Lesion Biology Index (LBI) framework. Read...

05 AUM MODALITY · VASCULAR CHARACTERISATION

Microvascular Flow Imaging

The vascular biological axis complementing the elastographic stiffness axis — anchored on the Mitao 2023, Frijlingh 2024, and Wang 2025 foundations across SMI, MV-Flow, and MFI commercial implementations, with the proposed two-axis LBI quadrant framework integrating vascular and mechanical lesion characterisation. Read...

06 AUM MODALITY · EXTRAPELVIC / NEUROPELVIC

Extrapelvic and Neuropelvic Endometriosis Mapping

The neuropelvic completion of the AUM tier addressing the sacral plexus, pudendal nerve, parametrium, and abdominal wall territories — built on the Szabó 2023 feasibility and Szabó 2024 sonomorphological foundations, with the Novasono two-approach (transvaginal + parasacral-transgluteal) protocol extension. Read...

07 STRUCTURED REPORTING SYSTEM

The #ENZIAN(u) Structured Reporting System

The 2021 revised #ENZIAN compartmental classification with the (u) ultrasound suffix — anchored on the Keckstein 2021 framework, the Enzelsberger 2022 cEnzian validation, the Hudelist 2022 comparison vs rASRM in 735 women, and the Montanari sonographic accuracy study, with the structured eleven-phase Novasono reporting protocol. Read...

08 COMORBID IMAGING TARGET · ADENOMYOSIS

Adenomyosis as a Co-Morbid Imaging Target

The 2022 revised MUSA framework with the formal direct vs indirect sign distinction — anchored on the Harmsen 2022 consensus, the Chapron 2017 FOAM-DIE 66.3% co-occurrence and the outside-to-inside invasion theory, with the proposed four-band AMC (Adenomyosis-MUSA Coupling) component of the NEPI classification. Read...

09 COMORBID IMAGING TARGET · OVARIAN

Endometriomas, IOTA Descriptors, and Ovarian Reserve

Structured adnexal imaging anchored on the IOTA simple descriptors and the 2020 O-RADS classification, with the ovarian reserve assessment built on the Raffi 2012, Somigliana 2012, Younis 2019, and Muzii 2018 meta-analyses (38% AMH decline after cystectomy; 30% unilateral vs 44% bilateral) and the proposed four-band OVR (Ovarian Reserve) component of the NEPI classification. Read...

10 CLINICAL APPLICATION · PRE-IVF MAPPING

Pre-IVF Mapping and Reproductive Endocrinology Integration

The AUM examination as the imaging foundation for the Endometriosis Fertility Index — anchored on the Adamson 2010 EFI (579 + 222 patient development and validation), the Hamdan 2015 endometrioma IVF meta-analysis, the Alson 2024 adenomyosis-IVF cohort (n=1037, direct features aRR 0.62), and the 2025 Trinchant euploid embryo transfer cohort. Read...

11 COMORBID IMAGING TARGET · PELVIC FLOOR

Pelvic Floor Coupling: Integrated Pelvic Floor and Endometriosis Assessment

The integrated pelvic floor and endometriosis assessment anchored on the 2019 AIUM/IUGA Practice Parameter — built on the Raimondo 2017 and 2022 cohorts and the Del Forno 2021 randomized controlled trial on PFM physiotherapy for DIE dyspareunia, with the four-stage pathogenetic model (inflammation → guarding → Levator Ani Syndrome → central sensitisation) and the proposed four-band PFC component of NEPI. Read...

12 PROPOSED MULTIDIMENSIONAL CLASSIFICATION

The NEPI Multidimensional Classification Proposal

The integrative proposal of the Novasono Endometriosis Phenotypic Index — nine component markers (ABS, SPE, LBI, SDQ, AMC, TID, PFC, OVR, TPS) feeding a five-band BI-RADS-analogue categorical layer and a four-component NEDS operational decision instrument (0–100 scale), positioned as a research framework for prospective validation by the broader endometriosis imaging community. Read...

13 PROPOSED ALGORITHM FOR PELVIC ADHESION SYNDROME

MS-PAS-Algorithm — Etiologic Discrimination of Pelvic Adhesion Syndrome: A Discriminator for Endometriosis Mapping.

The MS-PAS-Algorithm is a structured synthesis of individually reported sonographic components. It returns a probabilistic etiologic lean with a confidence band — not a tissue diagnosis — and is not a substitute for operative or histologic correlation in an individual patient. All feature weights and the decision cut-point are the clinical determination of the interpreting specialist. Read...

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