Utility of Vaginal and Rectal Contrast Medium in MRI for the Detection of Deep Pelvic Endometriosis

Overview

Journal Eur Radiol

Specialty Radiology

Date 2009 Oct 29

PMID 19862535

Citations 18

Authors

M Chassang

S Novellas

C Bloch-Marcotte

J Delotte

O Toullalan

A Bongain

P Chevallier

Affiliations

Soon will be listed here.

Abstract

Objective: To study the sensitivity of MRI performed utilising vaginal and rectal opacification with ultrasound gel in the detection of deep pelvic endometriosis.

Material And Methods: This was a prospective monocentric study. All patients evaluated by the gynaecologist for pelvic pain, endometriosis or infertility were included. Axial and sagittal T2-weighted images were performed both with and without vaginal and rectal opacification with ultrasound gel. Three radiologists, all blinded, interpreted the images with a minimum of 15 days between the two readings. MRI performance with and without vaginal and rectal opacification was evaluated by calculating sensitivity, specificity and both positive and negative predictive values.

Results: Seventy-eight patients were included. Among these, 31 patients had deep pelvic endometriosis of which 24 were confirmed by laparoscopy. Seventy-six locations of deep pelvic endometriosis were discovered on MRI. For the three reviewers there was a significant improvement in sensitivity between pre- and post-contrast MRI (p < 0.0002).

Conclusion: Opacification of the vagina and rectum significantly improved the sensitivity of MRI for the detection of deep pelvic endometriosis by expanding the vagina and rectum, thus allowing better delineation of the pelvic organs. This was especially apparent for lesions localised to the vagina and rectovaginal septum.

Citing Articles

MRI for endometriosis in adolescent patients.

El-Ali A, Tong A, Smereka P, Lala S Pediatr Radiol. 2024; 55(1):24-35.

PMID: 39289214 DOI: 10.1007/s00247-024-06050-z.

Diagnostic MRI for deep pelvic endometriosis: towards a standardized protocol?.

Thomassin-Naggara I, Zoua C, Bazot M, Monroc M, Roman H, Razakamanantsoa L Eur Radiol. 2024; 34(12):7705-7715.

PMID: 38958695 DOI: 10.1007/s00330-024-10842-0.

Bowel wall thickness measured by MRI is useful for early diagnosis of bowel endometriosis.

Zheng Y, Gu S, Ruan J, Yi X, Xu C Eur Radiol. 2023; 33(12):9244-9253.

PMID: 37498383 PMC: 10667399. DOI: 10.1007/s00330-023-09795-7.

The Role of Magnetic Resonance Imaging in the Planning of Surgical Treatment of Deep Pelvic Endometriosis.

Manti F, Battaglia C, Bruno I, Ammendola M, Navarra G, Curro G Front Surg. 2022; 9:944399.

PMID: 35836610 PMC: 9273906. DOI: 10.3389/fsurg.2022.944399.

Editorial: Current Innovations in Non-invasive Diagnoses and/or Surgical Treatments of Endometriosis.

Ayoubi J Front Surg. 2021; 8:699051.

PMID: 34901135 PMC: 8654927. DOI: 10.3389/fsurg.2021.699051.

References

Bazot M, Thomassin I, Hourani R, Cortez A, Darai E . Diagnostic accuracy of transvaginal sonography for deep pelvic endometriosis. Ultrasound Obstet Gynecol. 2004; 24(2):180-5. DOI: 10.1002/uog.1108. View

Brown M, Mattrey R, Stamato S, Sirlin C . MRI of the female pelvis using vaginal gel. AJR Am J Roentgenol. 2005; 185(5):1221-7. DOI: 10.2214/AJR.04.1660. View

Del Frate C, Girometti R, Pittino M, Del Frate G, Bazzocchi M, Zuiani C . Deep retroperitoneal pelvic endometriosis: MR imaging appearance with laparoscopic correlation. Radiographics. 2006; 26(6):1705-18. DOI: 10.1148/rg.266065048. View

Chapron C, Fauconnier A, Vieira M, Barakat H, Dousset B, Pansini V . Anatomical distribution of deeply infiltrating endometriosis: surgical implications and proposition for a classification. Hum Reprod. 2003; 18(1):157-61. DOI: 10.1093/humrep/deg009. View

Hollett-Caines J, Vilos G, Penava D . Laparoscopic mobilization of the rectosigmoid and excision of the obliterated cul-de-sac. J Am Assoc Gynecol Laparosc. 2003; 10(2):190-4. DOI: 10.1016/s1074-3804(05)60297-6. View

Abbott J, Hawe J, Clayton R, Garry R . The effects and effectiveness of laparoscopic excision of endometriosis: a prospective study with 2-5 year follow-up. Hum Reprod. 2003; 18(9):1922-7. DOI: 10.1093/humrep/deg275. View

Kinkel K, Frei K, Balleyguier C, Chapron C . Diagnosis of endometriosis with imaging: a review. Eur Radiol. 2005; 16(2):285-98. DOI: 10.1007/s00330-005-2882-y. View

Abrao M, Goncalves M, Dias Jr J, Podgaec S, Chamie L, Blasbalg R . Comparison between clinical examination, transvaginal sonography and magnetic resonance imaging for the diagnosis of deep endometriosis. Hum Reprod. 2007; 22(12):3092-7. DOI: 10.1093/humrep/dem187. View

Roy C, Balzan C, Thoma V, Sauer B, Wattiez A, Leroy J . Efficiency of MR imaging to orientate surgical treatment of posterior deep pelvic endometriosis. Abdom Imaging. 2008; 34(2):251-9. DOI: 10.1007/s00261-008-9367-9. View

10.

van Leeuwen E . Between scientific application and therapy: the ethical consideration. Dev Biol Stand. 1990; 71:161-70. View

11.

Ford J, English J, Miles W, Giannopoulos T . Pain, quality of life and complications following the radical resection of rectovaginal endometriosis. BJOG. 2004; 111(4):353-6. DOI: 10.1111/j.1471-0528.2004.00093.x. View

12.

Zanardi R, Del Frate C, Zuiani C, Bazzocchi M . Staging of pelvic endometriosis based on MRI findings versus laparoscopic classification according to the American Fertility Society. Abdom Imaging. 2003; 28(5):733-42. DOI: 10.1007/s00261-003-0005-2. View

13.

Chapron C, Dubuisson J, Pansini V, Vieira M, Fauconnier A, Barakat H . Routine clinical examination is not sufficient for diagnosing and locating deeply infiltrating endometriosis. J Am Assoc Gynecol Laparosc. 2002; 9(2):115-9. DOI: 10.1016/s1074-3804(05)60117-x. View

14.

Takeuchi H, Kuwatsuru R, Kitade M, Sakurai A, Kikuchi I, Shimanuki H . A novel technique using magnetic resonance imaging jelly for evaluation of rectovaginal endometriosis. Fertil Steril. 2005; 83(2):442-7. DOI: 10.1016/j.fertnstert.2004.08.021. View

15.

Mondot L, Novellas S, Senni M, Piche T, Dausse F, Caramella T . Pelvic prolapse: static and dynamic MRI. Abdom Imaging. 2006; 32(6):775-83. DOI: 10.1007/s00261-006-9168-y. View

16.

Redwine D, Wright J . Laparoscopic treatment of complete obliteration of the cul-de-sac associated with endometriosis: long-term follow-up of en bloc resection. Fertil Steril. 2001; 76(2):358-65. DOI: 10.1016/s0015-0282(01)01913-6. View

17.

Jarlot C, Anglade E, Paillocher N, Moreau D, Catala L, Aube C . [MR imaging features of deep pelvic endometriosis: correlation with laparoscopy]. J Radiol. 2008; 89(11 Pt 1):1745-54. DOI: 10.1016/s0221-0363(08)74479-2. View

18.

Urban M, Rosen H, Holbling N, Feil W, Hochwarther G, Hruby W . MR imaging for the preoperative planning of sphincter-saving surgery for tumors of the lower third of the rectum: use of intravenous and endorectal contrast materials. Radiology. 2000; 214(2):503-8. DOI: 10.1148/radiology.214.2.r00fe08503. View

19.

Koninckx P, Meuleman C, Demeyere S, Lesaffre E, Cornillie F . Suggestive evidence that pelvic endometriosis is a progressive disease, whereas deeply infiltrating endometriosis is associated with pelvic pain. Fertil Steril. 1991; 55(4):759-65. DOI: 10.1016/s0015-0282(16)54244-7. View

20.

Kataoka M, Togashi K, Yamaoka T, Koyama T, Ueda H, Kobayashi H . Posterior cul-de-sac obliteration associated with endometriosis: MR imaging evaluation. Radiology. 2005; 234(3):815-23. DOI: 10.1148/radiol.2343031366. View