MRI in deep endometriosis: can we reduce undertreatment?

Valerio Di Paola
2014 · doi:10.1594/ecr2014/c-1567 · W2528320217
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This 2014 ECR poster by Di Paola et al. investigates whether magnetic resonance imaging can reduce undertreatment in patients with deep endometriosis.

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This retrospective study evaluated the diagnostic accuracy of magnetic resonance imaging for deep infiltrating endometriosis by comparing MRI findings with histopathological results from surgical treatment. The researchers analyzed data from patients suspected of having tubo-ovarian or deep endometriosis, utilizing specific exclusion criteria to ensure comprehensive imaging and pathological confirmation were available for assessment. The results demonstrated an overall accuracy of 98% for detecting deep lesions, with particularly high precision observed in identifying involvement of the rectal-colic wall and uterosacral ligaments, although bladder lesions presented a significant limitation due to fibrotic characteristics and poor bladder filling. This paper is centrally about endometriosis — specifically the role of MRI in staging and accurately diagnosing deep infiltrating disease to potentially reduce undertreatment.

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Abstract

Poster: ECR 2014 / C-1567 / MRI in deep endometriosis: can we reduce undertreatment? by: V. Di Paola, F. Castelli, S. Mehrabi, R. Manfredi, R. Pozzi Mucelli; Verona/IT
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Keywords

Genital / Reproductive system female, MR, Staging Authors: V. Di Paola, F. Castelli, S. Mehrabi, R. Manfredi, R. Pozzi Mucelli; Verona/IT DOI: 10.1594/ecr2014/C-1567 Aims and objectives Endometriosis consists of the presence of endometrial glands and stroma outside of the uterine cavity (1), that is in the adnexa (tubo-ovarian endometriosis), or in the torus uterinus, recto-vaginal septum, utero-sacral ligament, pelvic wall or pelvic organs (deep endometriosis). Endometriosisis a disease involving 10% of patients (2), with a peak of incidence in childbearing age between 24 and 29 years, and causing chronic and invalidating pelvic pain in more than half of histologically confirmed cases (3) and infertility being present in 30% of infertile women...

Methods

and materials This retrospective study enrolled all Patients between December 2009 and April 2012 with suspected tubo-ovarian and/or deep endometriosis, whose data were considered for inclusion in our study. Patient data were included according to the following criteria: Patients with (a) tubo-ovarian and/or deep endometriosis suspected at physical examination and transvaginal ultrasound, (b) availability of MR examination findings, (c) histopathological results from laparoscopic or surgical treatment. Exclusion criteria were as follows: (a) There was a lack of available MR examination findings, and/or (b) There was a lack...

Results

At MRI we didn’t find any endometriosic lesions in 17/64 Patients (0 accordingly ENZIAN Score). In the other 47/64 Patients we found: 42 lesions in rectovaginal space of which 11 3 cm (3A); 21 lesions on uterosacral ligaments, of which 12 < 1 cm (1B) and 9 between 2 and 3 cm (2B); 12 lesions on rectal or colic wall, of which 7 < 1cm (1C), 4 between 2 and 3...

Conclusion

MRI has been demonstrated to have an accuracy of 98% for deep endometriosis, in accordance with recent literature results (10-12). In our work we found the highest accuracy for rectal-colic wall and for uterosacral ligaments, resulting higher than other works (13-14) probably due to the retrograde injection of gel through the rectum (15). The main limit was represented by bladder lesions, probably due to fibrotic constitution of the lesions (16) and to poor filling of the bladder. On conclusion, MRI has been demonstrated useful in...

References

1.L.Marcal, M. A.Nothaft, F. Coelho, and H. Choi.Deep pelvic endometriosis:MRimaging.Abdominal Imaging, vol. 35, no. 6, pp. 708–715, 2010. 2.Vigano P, Parazzini F, Somigliana E, Vercellini P. Endometriosis: epidemiology and aetiological factors.Best practice & research Clinical obstetrics & gynaecology 2004;18:177-200. 3.Triolo O, Lagana AS, Sturlese E. Chronic pelvic pain inendometriosis: an overview. Journal of clinical medicine research 2013;5:153-63. 4.Rogers PA,D'Hooghe TM, Fazleabas A. Defining future directions for endometriosis research: workshop report from the 2011 world congress of endometriosis in Montpellier,France. Reproductive sciences 2013;20:483-99. 5.Carvalho LF, Rossener...

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