Endometrial reflectivity (ultrasound grading)

Endometrial reflectivity grading on ultrasound is a system initially proposed by Smith et al. in 1984 which classifies the endometrium into four types according to the echotexture pattern. They are considered to be useful in deciding on receptivity in in-vitro fertilisation (IVF).

The Smith system is as follows:

  • grade A: hyperechoic
  • grade B: isoechoic
  • grade C: triple line / trilaminar
  • grade D: echogenic black region surrounding the midline echo

Further versions have been proposed subsequently which include a 3-grade system by Gonen and Casper in 1990. 

  • type a: entirely homogeneous, hyperechogenic pattern, without a central echogenic line
  • type b: intermediate iso-echogenic pattern, with the same reflectivity as the surrounding myometrium and a non-prominent or absent central echogenic line
  • type c: multilayered ‘triple-line’ endometrium consisting of a prominent outer and central hyperechogenic line and inner hypo-echogenic or black region

Or a two grade system by Sher et al. in 1991:

  • non-multilayered homogeneous hyperechogenic or iso-echogenic endometrium compared with the myometrium
  • multilayered triple-line multilayered pattern, ‘halo pattern’ = outer peripheral layer of denser echogenicity and a central sonolucent area.

See also 


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rID: 47996
Synonyms or Alternate Spellings:
  • Endometrial reflectivity grading ultrasound
  • Endometrial grading ultrasound
  • Endometrial sonographic reflectivity grading
  • Endometrial reflectivity grading

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