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Takeuchi M, Matsuzaki K, Harada M. Endometriosis, a common but enigmatic disease with many faces: current concept of pathophysiology, and diagnostic strategy. Jpn J Radiol 2024:10.1007/s11604-024-01569-5. [PMID: 38658503 DOI: 10.1007/s11604-024-01569-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/06/2024] [Indexed: 04/26/2024]
Abstract
Endometriosis is a benign, common, but controversial disease due to its enigmatic etiopathogenesis and biological behavior. Recent studies suggest multiple genetic, and environmental factors may affect its onset and development. Genomic analysis revealed the presence of cancer-associated gene mutations, which may reflect the neoplastic aspect of endometriosis. The management has changed dramatically with the development of fertility-preserving, minimally invasive therapies. Diagnostic strategies based on these recent basic and clinical findings are reviewed. With a focus on the presentation of clinical cases, we discuss the imaging manifestations of endometriomas, deep endometriosis, less common site and rare site endometriosis, various complications, endometriosis-associated tumor-like lesions, and malignant transformation, with pathophysiologic conditions.
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Affiliation(s)
- Mayumi Takeuchi
- Department of Radiology, Tokushima University, 3-18-15, Kuramoto-Cho, Tokushima, 7708503, Japan.
| | - Kenji Matsuzaki
- Department of Radiological Technology, Tokushima Bunri University, Sanuki City, ShidoKagawa, 1314-17692193, Japan
| | - Masafumi Harada
- Department of Radiology, Tokushima University, 3-18-15, Kuramoto-Cho, Tokushima, 7708503, Japan
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2
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Zhong W, Zhang L, Zhong JQ, He XP, Liu HQ, Zhu WQ, Fang CF. Comparison of outcomes between preservation or division of the uterine round ligament in laparoscopic groin hernia repair in females: a meta-analysis and trial sequential analysis. Hernia 2024; 28:343-354. [PMID: 38165537 PMCID: PMC10997534 DOI: 10.1007/s10029-023-02917-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/14/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE The purpose of this study was to perform a meta-analysis comparing the short-term and long-term outcomes in laparoscopic groin hernia repair with or without preservation of the uterine round ligament (URL) in females. METHODS We searched several databases including PubMed, Web of Science, Cochrane Library, and and CNKI databases. This meta-analysis included randomized clinical trials, and retrospective comparative studies regarding preservation or division of the URL in laparoscopic groin hernia repair in females. Outcomes of interest were age, BMI, type of hernia, type of surgery, operating time, estimated blood loss, time of hospitalization, seroma, concomitant injury, mesh infection, recurrence, uterine prolapse, foreign body sensation, chronic pain, and pregnancy. Meta-analyses and trial sequential analysis were performed with Review Manager v5.3 and TSA software, respectively. RESULTS Of 192 potentially eligible articles, 9 studies with 1104 participants met the eligibility criteria and were included in the meta-analysis. There were no significant difference in age (MD-6.58, 95% CI - 13.41 to 0.24; P = 0.06), BMI (MD 0.05, 95%CI - 0.31 to 0.40; P = 0.81), blood loss (MD-0.04, 95% CI - 0.75 to 0.66; P = 0.90), time of hospitalization (MD-0.22, 95% CI-1.13 to 0.69; P = 0.64), seroma (OR 0.71, 95% CI 0.41 to 1.24; P = 0.23), concomitant injury (OR 0.32, 95% CI 0.01 to 8.24; P = 0.68), mesh infection (OR 0.13, 95% CI 0.01 to 2.61; P = 0.18), recurrence (OR 1.13, 95% CI 0.18 to 7.25; P = 0.90), uterine prolapse(OR 0.71, 95% CI 0.07 to 6.94; P = 0.77), foreign body sensation (OR 1.95, 95% CI 0.53 to 7.23; P = 0.32) and chronic pain(OR 1.03 95% CI 0.4 to 2.69; P = 0.95). However, this meta-analysis demonstrated a statistically significant difference in operating time (MD 6.62, 95% CI 2.20 to 11.04; P = 0.0003) between the preservation group and division group. Trial sequential analysis showed that the cumulative Z value of the operating time crossed the traditional boundary value and the TSA boundary value in the third study, and the cumulative sample size had reached the required information size (RIS), indicating that the current conclusion was stable. CONCLUSION In summary, laparoscopic groin hernia repair in women with the preservation of the round uterine ligament requires a longer operating time, but there was no advantage in short-term or long-term complications, and there was no clear evidence on whether it causes infertility and uterine prolapse.
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Affiliation(s)
- W Zhong
- Department of Gastrointestinal Surgery, The Ganzhou People's Hospital, Ganzhou, China
| | - L Zhang
- Department of Gastrointestinal Surgery, The Ganzhou People's Hospital, Ganzhou, China
| | - J Q Zhong
- Department of Gastrointestinal Surgery, The Ganzhou People's Hospital, Ganzhou, China
| | - X P He
- Department of Gastrointestinal Surgery, The Ganzhou People's Hospital, Ganzhou, China
| | - H Q Liu
- Department of Gastrointestinal Surgery, The Ganzhou People's Hospital, Ganzhou, China
| | - W Q Zhu
- Department of Gastrointestinal Surgery, The Ganzhou People's Hospital, Ganzhou, China
| | - C F Fang
- Department of Gastrointestinal Surgery, The Ganzhou People's Hospital, Ganzhou, China.
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Kohlhauser M, Pirsch JV, Maier T, Viertler C, Fegerl R. The Cyst of the Canal of Nuck: Anatomy, Diagnostic and Treatment of a Very Rare Diagnosis-A Case Report of an Adult Woman and Narrative Review of the Literature. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1353. [PMID: 36295514 PMCID: PMC9609622 DOI: 10.3390/medicina58101353] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/20/2022] [Accepted: 09/23/2022] [Indexed: 08/25/2023]
Abstract
The cyst of the canal of Nuck is an extremely rare female hydrocele, usually occurring in children, but also in adult women. It is caused by pathology of the canal of Nuck, which is the female equivalent to the male processus vaginalis. Due to its rarity and the lack of awareness among physicians, the cyst of the canal of Nuck is a seldom-encountered entity in clinical practice and is commonly misdiagnosed. We report on a case of cyst of the canal of Nuck in a 42-year-old woman, who presented with a painful swelling at her right groin. In addition, we conducted a review of the current available literature. This review gives an overview of the anatomy, pathology, diagnostics, and treatment of the cyst of the canal of Nuck. The aim of this review is not only to give a survey, but also to raise awareness of the cyst of the canal of Nuck and serve as a reference for medical professionals.
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Affiliation(s)
- Michael Kohlhauser
- Department of Surgery, State Hospital Weiz, Styrian Hospital Association (KAGes), 8160 Weiz, Austria
| | - Julian Vinzent Pirsch
- Department of Surgery, State Hospital Weiz, Styrian Hospital Association (KAGes), 8160 Weiz, Austria
| | - Thorsten Maier
- Radiological Center Weiz, Institute for CT and MRI Weiz OG, 8160 Weiz, Austria
| | - Christian Viertler
- Diagnostic and Research Institute of Pathology, Medical University of Graz, 8010 Graz, Austria
| | - Roland Fegerl
- Department of Surgery, State Hospital Weiz, Styrian Hospital Association (KAGes), 8160 Weiz, Austria
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Pietro P, Adele MM, Donatella DF, Antonino C, Pietro A, Emanuele S, Alfredo B, Giorgio A, Carmelo S. Spontaneous round ligament hematoma as an unusual cause of pelvic pain in a young female patient: MRI demonstration. Radiol Case Rep 2022; 17:1765-1769. [PMID: 35355531 PMCID: PMC8958461 DOI: 10.1016/j.radcr.2022.02.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 02/23/2022] [Accepted: 02/23/2022] [Indexed: 11/24/2022] Open
Abstract
The cause of pelvic pain remains a significant diagnostic challenge, even for experienced radiologists. An accurate differential diagnosis has to be done according to the patient's age and gender. Spontaneous round ligament hematoma is an uncommon cause of acute pelvic pain in adult female patients. To the best of our knowledge, it has never been reported in the literature in the paediatric population. Ultrasound examination is the first line imaging modality for pelvic pain evaluation in young women but it might result inconclusive. Thanks to its panoramic view and multiparametric approach, the MRI can play a pivotal role in the diagnosis of spontaneous round ligament hematoma in paediatric female patients, resulting in a more effective patient's therapeutic management.
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Affiliation(s)
- Pitrone Pietro
- Section of Radiological Sciences, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino" Via Consolare Valeria 1, Messina 98100, Italy
| | - Marino Maria Adele
- Section of Radiological Sciences, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino" Via Consolare Valeria 1, Messina 98100, Italy
| | - Di Fabrizio Donatella
- Department of Human Pathology of Adult and Childhood "Gaetano Barresi", Unit of Pediatric Surgery, University of Messina, Policlinico "G. Martino" Via Consolare Valeria 1, Messina 98100, Italy
| | - Cattafi Antonino
- Section of Radiological Sciences, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino" Via Consolare Valeria 1, Messina 98100, Italy
| | - Antonuccio Pietro
- Department of Human Pathology of Adult and Childhood "Gaetano Barresi", Unit of Pediatric Surgery, University of Messina, Policlinico "G. Martino" Via Consolare Valeria 1, Messina 98100, Italy
| | - Sturlese Emanuele
- Department of Obstetrics and Gynecology, University of Messina, Policlinico "G. Martino" Via Consolare Valeria 1, Messina 98100, Italy
| | - Blandino Alfredo
- Section of Radiological Sciences, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino" Via Consolare Valeria 1, Messina 98100, Italy
| | - Ascenti Giorgio
- Section of Radiological Sciences, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino" Via Consolare Valeria 1, Messina 98100, Italy
| | - Sofia Carmelo
- Section of Radiological Sciences, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Policlinico "G. Martino" Via Consolare Valeria 1, Messina 98100, Italy
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Testini V, Eusebi L, Grechi G, Bartelli F, Guglielmi G. Imaging of Endometriosis: The Role of Ultrasound and Magnetic Resonance. CURRENT RADIOLOGY REPORTS 2022. [DOI: 10.1007/s40134-022-00393-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AbstractEndometriosis is a chronic gynecological disease characterized by the growth of functional ectopic endometrial glands and stroma outside the uterus. It causes pelvic pain, dysmenorrhea, dyspareunia, or infertility. Diagnosis requires a combination of clinical history, non-invasive and invasive techniques. The aim of the present review was to evaluate the contribution of imaging techniques, mainly transvaginal sonography and magnetic resonance imaging to diagnose different locations and for the most appropriate treatment planning. Endometriosis requires a multidisciplinary teamwork to manage these patients clinically and surgically.
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Kido A, Himoto Y, Moribata Y, Kurata Y, Nakamoto Y. MRI in the Diagnosis of Endometriosis and Related Diseases. Korean J Radiol 2022; 23:426-445. [PMID: 35289148 PMCID: PMC8961012 DOI: 10.3348/kjr.2021.0405] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 10/15/2021] [Accepted: 11/11/2021] [Indexed: 11/15/2022] Open
Abstract
Endometriosis, a common chronic inflammatory disease in female of reproductive age, is closely related to patient symptoms and fertility. Because of its high contrast resolution and objectivity, MRI can contribute to the early and accurate diagnosis of ovarian endometriotic cysts and deeply infiltrating endometriosis without the need for any invasive procedure or radiation exposure. The ovaries, which are the most frequent site of endometriosis, can be afflicted by multiple related conditions and diseases. For the diagnosis of deeply infiltrating endometriosis and secondary adhesions among pelvic organs, fibrosis around the ectopic endometrial gland is usually found as a T2 hypointense lesion. This review summarizes the MRI findings obtained for ovarian endometriotic cysts and their physiologically and pathologically related conditions. This article also includes the key imaging findings of deeply infiltrating endometriosis.
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Affiliation(s)
- Aki Kido
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Hospital, Kyoto, Japan
| | - Yuki Himoto
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Hospital, Kyoto, Japan
| | - Yusaku Moribata
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Hospital, Kyoto, Japan
| | - Yasuhisa Kurata
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Hospital, Kyoto, Japan
| | - Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Hospital, Kyoto, Japan
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Mu B, Zhang Z, Liu C, Zhang K, Li S, Leng J, Li M. Long term follow-up of inguinal endometriosis. BMC WOMENS HEALTH 2021; 21:90. [PMID: 33653321 PMCID: PMC7927249 DOI: 10.1186/s12905-021-01235-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 02/22/2021] [Indexed: 12/30/2022]
Abstract
Background Inguinal endometriosis (IEM) is a rare extra pelvic endometriosis. Here, we study the clinical characteristics, management strategies, and long-term gynecological outcomes of IEM patients at Beijing Chaoyang Hospital. Case presentation Three patients presented with a total of four lesions (one on the left side, one on the right side, and one bilaterally). The diameters of the four lesions were 2 cm, 2 cm, 3.5 cm and 1.5 cm, respectively. Two patients were admitted with inguinal hernias. Two patients were admitted with endometrioses—one with ovarian endometriosis and one with pelvic endometriosis. The hernia sac was repaired concomitantly via excision of the round ligament in two patients. One patient underwent a concomitant laparoscopy for gynecologic evaluations, including an ablation to the peritoneal endometriosis, and resection of the left uterosacral ligament endometriosis and pelvic adhesiolysis. All lesions were located on the extraperitoneal portion of the round ligament and were diagnosed histologically. No recurrence was observed in the inguinal region. All patients diagnosed with adenomyosis were treated with medication alone without any complaints. Conclusions Inguinal endometriosis can occur simultaneously with pelvic endometriosis. In most cases, a concomitant hernia sac appears together with groin endometriosis. Clinical management should be individualized and performed in tandem with general practitioners and obstetrics & gynecology experts. Pelvic disease, in particular, should be followed-up by a gynecologist.
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Affiliation(s)
- BoRan Mu
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital Affiliated To Capital Medical University, 8 Gongtinanlu, ChaoYang District, Beijing, 100020, People's Republic of China
| | - ZhiQiang Zhang
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital Affiliated To Capital Medical University, 8 Gongtinanlu, ChaoYang District, Beijing, 100020, People's Republic of China
| | - Chongdong Liu
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital Affiliated To Capital Medical University, 8 Gongtinanlu, ChaoYang District, Beijing, 100020, People's Republic of China
| | - Kunning Zhang
- Department of Pathology, Beijing Chao-Yang Hospital Affiliated to Capital Medical University, 8 Gongtinanlu, ChaoYang District, Beijing, 100020, People's Republic of China
| | - ShuHong Li
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital Affiliated To Capital Medical University, 8 Gongtinanlu, ChaoYang District, Beijing, 100020, People's Republic of China
| | - JinHua Leng
- Department of Obstetrics and Gynecology, Peking Union Medical College (PUMC) Hospital, No. 1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, 100730, People's Republic of China.
| | - MengHui Li
- Department of Obstetrics and Gynecology, Beijing Chao-Yang Hospital Affiliated To Capital Medical University, 8 Gongtinanlu, ChaoYang District, Beijing, 100020, People's Republic of China.
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Systematic interpretation and structured reporting for pelvic magnetic resonance imaging studies in patients with endometriosis: value added for improved patient care. Abdom Radiol (NY) 2020; 45:1608-1622. [PMID: 31446452 DOI: 10.1007/s00261-019-02182-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Endometriosis is a chronic, multifocal disease, which can lead to pain or subfertility. Treatments are tailored toward the therapeutic goals of the individual patient; either to improve a specific pain symptom or optimize fertility. Management of endometriosis is complex, and best implemented by a comprehensive, multidisciplinary team of physicians and health care providers. The role of the radiologist in the management of endometriosis is becoming increasingly important as more centers move toward utilizing female pelvic MR studies to diagnose, delineate or follow endometriosis lesions. The radiologist must communicate pertinent, actionable findings from these studies in a manner that is clear and concise. Structured radiologic reports (SRR) add value in that they provide organized, clear, and comprehensive information from imaging studies, ensuring reports include essential items required for decision-making. In this paper, we review our MR imaging protocol and present the structured radiologic report implemented at our institution by our multidisciplinary endometriosis care team. Imaging features of endometriosis at each site specified in the structured report are summarized. The importance of each element included in the structured report from a management perspective is highlighted.
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Di Maida F, Mari A, Morselli S, Campi R, Sforza S, Cocci A, Tellini R, Tuccio A, Petraglia F, Masieri L, Carini M, Minervini A. Robotic treatment for urinary tract endometriosis: preliminary results and surgical details in a high-volume single-Institutional cohort study. Surg Endosc 2020; 34:3236-3242. [PMID: 32170566 DOI: 10.1007/s00464-020-07502-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 03/02/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Aim of the study was to present the surgical techniques and the postoperative outcomes in women treated with robotic excision for deep endometriosis involving the urinary tract. MATERIALS AND METHODS We retrospectively reviewed the prospectively recorded clinical data of women consecutively undergoing minimally invasive treatment for complex endometriosis involving urinary tract in our center between January 2012 and June 2018. All the patients received a preoperative multidisciplinary evaluation with the general surgeon, the gynecologist and the urologist due to the frequent concomitant involvement of bowel and genital system. Patients undergoing robotic surgery were treated with the Si or Xi da Vinci surgical system. RESULTS A total of 74 consecutive patients were enrolled. Twenty-eight (37.8%) patients underwent conventional laparoscopy and 46 (62.2%) robotic surgery. Only patients treated with robotic approach were considered for the final analyses. Overall, 17 (36.9%) patients were treated with partial cystectomy, 13 (28.3%) with ureteral reimplantation, 10 (21.7%) patients were treated with ureteral lysis, 4 (8.7%) with removal of bladder endometrial node without opening the mucosa layer and 2 (4.3%) with ureteral end-to-end anastomosis. Concomitant involvement of bowel and genital system was registered in 14 (30.4%) and 32 (69.5%) patients, respectively. No conversions to laparotomy were recorded. Overall, 5 (10.9%) patients experienced postoperative complications, of which only one was a major complication (Clavien 3b). At a median follow-up of 31.3 (IQR 17.6-43.3) months, 4 (8.7%) patients experienced disease recurrence at the level of urinary tract. CONCLUSIONS Robotic excision of urological endometriosis represents a safe and effective treatment option, since a limited rate of surgical complications was recorded even in cases of multi-organ disease.
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Affiliation(s)
- Fabrizio Di Maida
- Department of Urology, University of Florence, Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi University Hospital, San Luca Nuovo, Florence, Italy
| | - Andrea Mari
- Department of Urology, University of Florence, Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi University Hospital, San Luca Nuovo, Florence, Italy
| | - Simone Morselli
- Department of Urology, University of Florence, Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi University Hospital, San Luca Nuovo, Florence, Italy
| | - Riccardo Campi
- Department of Urology, University of Florence, Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi University Hospital, San Luca Nuovo, Florence, Italy
| | - Simone Sforza
- Department of Urology, University of Florence, Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi University Hospital, San Luca Nuovo, Florence, Italy
| | - Andrea Cocci
- Department of Urology, University of Florence, Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi University Hospital, San Luca Nuovo, Florence, Italy
| | - Riccardo Tellini
- Department of Urology, University of Florence, Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi University Hospital, San Luca Nuovo, Florence, Italy
| | - Agostino Tuccio
- Department of Urology, University of Florence, Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi University Hospital, San Luca Nuovo, Florence, Italy
| | - Felice Petraglia
- Department of Gynecology and Obstestrics, University of Florence, Careggi Hospital, Florence, Italy
| | - Lorenzo Masieri
- Department of Urology, University of Florence, Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi University Hospital, San Luca Nuovo, Florence, Italy
| | - Marco Carini
- Department of Urology, University of Florence, Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi University Hospital, San Luca Nuovo, Florence, Italy
| | - Andrea Minervini
- Department of Urology, University of Florence, Unit of Oncologic Minimally-Invasive Urology and Andrology, Careggi University Hospital, San Luca Nuovo, Florence, Italy.
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Hindman N, VanBuren W. Imaging Spectrum of Endometriosis (Endometriomas to Deep Infiltrative Endometriosis). Radiol Clin North Am 2020; 58:275-289. [DOI: 10.1016/j.rcl.2019.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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11
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Gkegkes ID, Iavazzo C, Iatrakis G, Iavazzo PE, Pechlivani F, Antoniou E, Bakalianou K. Robotic Management of Endometriosis: Discussion of Use, Criteria and Advantages: a Review of the Literature. ACTA MEDICA (HRADEC KRÁLOVÉ) 2020; 62:147-149. [PMID: 32036846 DOI: 10.14712/18059694.2020.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Endometriosis is a very common benign condition affecting fertility and quality of life. Different methods, either definitive or fertility sparing are used for its management by using open, laparoscopic, and robotic techniques. This is a literature review presenting the role and the advantages of robotic surgery in endometriosis. Such a management is effective, safe, and feasible in hands of well-trained multidisciplinary teams even for severe cases of endometriosis.
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Affiliation(s)
- Ioannis D Gkegkes
- Department of Surgery, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK.
| | - Christos Iavazzo
- Department of Gynaecological Oncology, The Christie Hospital, Manchester, UK
| | - George Iatrakis
- Department of Obstetrics and Gynaecology, Technological Educational Institution of Athens, Athens, Greece
| | | | - Fani Pechlivani
- Department of Obstetrics and Gynaecology, Technological Educational Institution of Athens, Athens, Greece
| | - Evangelia Antoniou
- Department of Obstetrics and Gynaecology, Technological Educational Institution of Athens, Athens, Greece
| | - Konstadia Bakalianou
- Department of Obstetrics and Gynecology, General Hospital "Agia Olga", Athens, Greece
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Kaniewska M, Gołofit P, Heubner M, Maake C, Kubik-Huch RA. Suspensory Ligaments of the Female Genital Organs: MRI Evaluation with Intraoperative Correlation. Radiographics 2019; 38:2195-2211. [PMID: 30422765 DOI: 10.1148/rg.2018180089] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The uterus, which plays an important role in the reproductive process, provides a home for the developing fetus and so must be in a stable, though flexible, location. Various structures with suspensory ligaments help provide this berth. MRI with high spatial resolution allows us to detect and evaluate these relatively fine structures. Under physiologic conditions, MRI can be used to depict uterine and ovarian ligaments (ie, the uterosacral, cardinal, and round ligaments, as well as the suspensory ligament of the ovary). In the presence of pathologic conditions (inflammation, endometriosis, tumors), the suspensory ligaments may appear thickened or invaded, which makes their delineation easier. Understanding the normal anatomy of the suspensory ligaments of the female genital organs and using a standardized nomenclature are essential for identifying and reporting related pathologic conditions. The female pelvic anatomy and the suspensory ligaments of the female genital organs are described as depicted with MRI. Also, the compartmental anatomy of the female pelvis is explained, including the extraperitoneal pelvic spaces. Finally, a checklist is provided for structured reporting of the MRI findings in the female pelvis. Online supplemental material is available for this article. ©RSNA, 2018.
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Affiliation(s)
- Malwina Kaniewska
- From the Department of Radiology (M.K., R.A.K.) and the Institute of Gynecology (M.H.), Kantonsspital Baden, Baden, Switzerland; the Department of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University Clinical Hospital No. 1, Szczecin, Poland (P.G.); and the Institute of Anatomy, University of Zurich, Zurich, Switzerland (C.M.)
| | - Piotr Gołofit
- From the Department of Radiology (M.K., R.A.K.) and the Institute of Gynecology (M.H.), Kantonsspital Baden, Baden, Switzerland; the Department of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University Clinical Hospital No. 1, Szczecin, Poland (P.G.); and the Institute of Anatomy, University of Zurich, Zurich, Switzerland (C.M.)
| | - Martin Heubner
- From the Department of Radiology (M.K., R.A.K.) and the Institute of Gynecology (M.H.), Kantonsspital Baden, Baden, Switzerland; the Department of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University Clinical Hospital No. 1, Szczecin, Poland (P.G.); and the Institute of Anatomy, University of Zurich, Zurich, Switzerland (C.M.)
| | - Caroline Maake
- From the Department of Radiology (M.K., R.A.K.) and the Institute of Gynecology (M.H.), Kantonsspital Baden, Baden, Switzerland; the Department of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University Clinical Hospital No. 1, Szczecin, Poland (P.G.); and the Institute of Anatomy, University of Zurich, Zurich, Switzerland (C.M.)
| | - Rahel A Kubik-Huch
- From the Department of Radiology (M.K., R.A.K.) and the Institute of Gynecology (M.H.), Kantonsspital Baden, Baden, Switzerland; the Department of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University Clinical Hospital No. 1, Szczecin, Poland (P.G.); and the Institute of Anatomy, University of Zurich, Zurich, Switzerland (C.M.)
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Gandhi J, Zaidi S, Suh Y, Joshi G, Smith NL, Ali Khan S. An index of inguinal and inguinofemoral masses in women: Critical considerations for diagnosis. TRANSLATIONAL RESEARCH IN ANATOMY 2018. [DOI: 10.1016/j.tria.2018.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Espada M, Alvarez-Moreno E, Jimenez de la Pena M, Munoz Capio V, Reid S, Condous G. Imaging techniques in endometriosis. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2018. [DOI: 10.1177/2284026518773215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Endometriosis is a common gynecological condition affecting up to 15% of the general female population. Here, we present a systematic review of imaging techniques of endometriosis. The aim of this review is to determine the most accurate site-specific preoperative diagnostic tools in order to map, locate, evaluate the extension, and stage the disease. There are important reasons to stage endometriosis: to create a common language, to enable specificity of diagnosis, standardize comparisons, and to facilitate research applications. The requirements of an ideal endometriosis classification system are that it be empirically and scientifically based, be of general consensus, have unambiguous definition of terms, be comprehensive in all cases, have a simple translation from anatomic features to verbal description, reflect disease, predict fertility, predict pain relief, be useful to guide treatment, indicate risk of recurrence, identify clinical situations in which it does not apply, be simple to calculate, and be easy to communicate to women. An extensive search of papers regarding imaging techniques in endometriosis was performed in Pubmed from January 1992 to February 2018, including original peer-reviewed papers, reviews, and international guidelines.
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Affiliation(s)
- Mercedes Espada
- Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Sydney Medical School Nepean, Nepean Hospital, The University of Sydney, Penrith, NSW, Australia
| | | | | | | | - Shannon Reid
- Department of Obstetrics and Gynaecology, Wollongong Hospital, Wollongong, NSW, Australia
| | - George Condous
- Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Sydney Medical School Nepean, Nepean Hospital, The University of Sydney, Penrith, NSW, Australia
- OMNI Ultrasound & Gynaecological Care, Centre for Women’s Ultrasound and Early Pregnancy, Sydney, NSW, Australia
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Simó Alari F, Caveriviere P, Gutierrez I, Gillon C. Laparoscopic excision of round ligament endometrioma. BMJ Case Rep 2018; 2018:bcr-2017-223613. [PMID: 29960956 DOI: 10.1136/bcr-2017-223613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 14-year-old female patient consulted due to 4 months of recurrent right pelvic pain during her menstrual period. Sonography revealed a 35 mm haemorrhagic right ovarian cyst, initially treated with hormone therapy and oral analgesics with no response. Surgery was indicated due to growth on sonography control and no response to medical treatment. Laparoscopy showed a 7 cm leiomyomatous-like mass arising from the right round ligament that was extracted en bloc without rupture with right salpingectomy and ovarian preservation. The histopathological examination confirmed the diagnosis of round ligament endometrioma with no atypia. The patient presented an uncomplicated postoperative course and was discharged home 48 hours after surgery. Hormonal contraceptives were initiated after the histopathological confirmation; the patient remains asymptomatic at 1-year follow-up.
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Affiliation(s)
- Francesc Simó Alari
- Chirurgie gynécologique et viscerale, Centre hospitalier du val d'Ariege, Foix, France
| | | | - Israel Gutierrez
- Chirurgie gynécologique et viscerale, Centre hospitalier du val d'Ariege, Foix, France
| | - Claire Gillon
- Gynécologie et obstétrique, Centre hospitalier du val d'Ariege, Foix, France
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Guerriero S, Saba L, Pascual MA, Ajossa S, Rodriguez I, Mais V, Alcazar JL. Transvaginal ultrasound vs magnetic resonance imaging for diagnosing deep infiltrating endometriosis: systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 51:586-595. [PMID: 29154402 DOI: 10.1002/uog.18961] [Citation(s) in RCA: 137] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 11/08/2017] [Accepted: 11/10/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To perform a systematic review of studies comparing the accuracy of transvaginal ultrasound (TVS) and magnetic resonance imaging (MRI) in diagnosing deep infiltrating endometriosis (DIE) including only studies in which patients underwent both techniques. METHODS An extensive search was carried out in PubMed/MEDLINE and Web of Science for papers from January 1989 to October 2016 comparing TVS and MRI in DIE. Studies were considered eligible for inclusion if they reported on the use of TVS and MRI in the same set of patients for the preoperative detection of endometriosis in pelvic locations in women with clinical suspicion of DIE and using surgical data as a reference standard. Quality was assessed using the QUADAS-2 tool. A random-effects model was used to determine pooled sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR-) and diagnostic odds ratio (DOR). RESULTS Of 375 citations identified, six studies (n = 424) were considered eligible. For MRI in the detection of DIE in the rectosigmoid, pooled sensitivity was 0.85 (95% CI, 0.78-0.90), specificity was 0.95 (95% CI, 0.83-0.99), LR+ was 18.4 (95% CI, 4.7-72.4), LR- was 0.16 (95% CI, 0.11-0.24) and DOR was 116 (95% CI, 23-585). For TVS in the detection of DIE in the rectosigmoid, pooled sensitivity was 0.85 (95% CI, 0.68-0.94), specificity was 0.96 (95% CI, 0.85-0.99), LR+ was 20.4 (95% CI, 4.7-88.5), LR- was 0.16 (95% CI, 0.07-0.38) and DOR was 127 (95% CI, 14-1126). For MRI in the detection of DIE in the rectovaginal septum, pooled sensitivity was 0.66 (95% CI, 0.51-0.79), specificity was 0.97 (95% CI, 0.89-0.99), LR+ was 22.5 (95% CI, 6.7-76.2), LR- was 0.38 (95% CI, 0.23-0.52) and DOR was 65 (95% CI, 21-204). For TVS in the detection of DIE in the rectovaginal septum, pooled sensitivity was 0.59 (95% CI, 0.26-0.86), specificity was 0.97 (95% CI, 0.94-0.99), LR+ was 23.5 (95% CI, 9.1-60.5), LR- was 0.42 (95% CI, 0.18-0.97) and DOR was 56 (95% CI, 11-275). For MRI in the detection of DIE in the uterosacral ligaments, pooled sensitivity was 0.70 (95% CI, 0.55-0.82), specificity was 0.93 (95% CI, 0.87-0.97), LR+ was 10.4 (95% CI, 5.1-21.2), LR- was 0.32 (95% CI, 0.20-0.51) and DOR was 32 (95% CI, 12-85). For TVS in the detection of DIE in the uterosacral ligaments, pooled sensitivity was 0.67 (95% CI, 0.55-0.77), specificity was 0.86 (95% CI, 0.73-0.93), LR+ was 4.8 (95% CI, 2.6-9.0), LR- was 0.38 (95% CI, 0.29-0.50) and DOR was 12 (95% CI, 7-24). Confidence intervals of pooled sensitivities, specificities and DOR were wide for both techniques in all the locations considered. Heterogeneity was moderate or high for sensitivity and specificity for both TVS and MRI in most locations assessed. According to QUADAS-2, the quality of the included studies was considered good for most domains. CONCLUSION The diagnostic performance of TVS and MRI is similar for detecting DIE involving rectosigmoid, uterosacral ligaments and rectovaginal septum. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- S Guerriero
- Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, Monserrato, Cagliari, Italy
| | - L Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), Monserrato, Italy
| | - M A Pascual
- Department of Obstetrics, Gynecology and Reproduction, Institut Universitari Dexeus, Barcelona, Spain
| | - S Ajossa
- Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, Monserrato, Cagliari, Italy
| | - I Rodriguez
- Department of Obstetrics, Gynecology and Reproduction, Institut Universitari Dexeus, Barcelona, Spain
| | - V Mais
- Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, Monserrato, Cagliari, Italy
| | - J L Alcazar
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, School of Medicine, University of Navarra, Pamplona, Spain
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Foti PV, Farina R, Palmucci S, Vizzini IAA, Libertini N, Coronella M, Spadola S, Caltabiano R, Iraci M, Basile A, Milone P, Cianci A, Ettorre GC. Endometriosis: clinical features, MR imaging findings and pathologic correlation. Insights Imaging 2018; 9:149-172. [PMID: 29450853 PMCID: PMC5893487 DOI: 10.1007/s13244-017-0591-0] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 12/11/2017] [Accepted: 12/27/2017] [Indexed: 12/23/2022] Open
Abstract
Objective We illustrate the magnetic resonance imaging (MRI) features of endometriosis. Background Endometriosis is a chronic gynaecological condition affecting women of reproductive age and may cause pelvic pain and infertility. It is characterized by the growth of functional ectopic endometrial glands and stroma outside the uterus and includes three different manifestations: ovarian endometriomas, peritoneal implants, deep pelvic endometriosis. The primary locations are in the pelvis; extrapelvic endometriosis may rarely occur. Diagnosis requires a combination of clinical history, invasive and non-invasive techniques. The definitive diagnosis is based on laparoscopy with histological confirmation. Diagnostic imaging is necessary for treatment planning. MRI is as a second-line technique after ultrasound. The MRI appearance of endometriotic lesions is variable and depends on the quantity and age of haemorrhage, the amount of endometrial cells, stroma, smooth muscle proliferation and fibrosis. The purpose of surgery is to achieve complete resection of all endometriotic lesions in the same operation. Conclusion Owing to the possibility to perform a complete assessment of all pelvic compartments at one time, MRI represents the best imaging technique for preoperative staging of endometriosis, in order to choose the more appropriate surgical approach and to plan a multidisciplinary team work. Teaching Points • Endometriosis includes ovarian endometriomas, peritoneal implants and deep pelvic endometriosis. • MRI is a second-line imaging technique after US. • Deep pelvic endometriosis is associated with chronic pelvic pain and infertility. • Endometriosis is characterized by considerable diagnostic delay. • MRI is the best imaging technique for preoperative staging of endometriosis.
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Affiliation(s)
- Pietro Valerio Foti
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy.
| | - Renato Farina
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Stefano Palmucci
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Ilenia Anna Agata Vizzini
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Norma Libertini
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Maria Coronella
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Saveria Spadola
- Department G.F. Ingrassia - Institute of Pathology, University of Catania, Catania, Italy
| | - Rosario Caltabiano
- Department G.F. Ingrassia - Institute of Pathology, University of Catania, Catania, Italy
| | - Marco Iraci
- Department of General Surgery and Medical-Surgical Specialties - Institute of Obstetrics and Ginecology, University of Catania, Catania, Italy
| | - Antonio Basile
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Pietro Milone
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Antonio Cianci
- Department of General Surgery and Medical-Surgical Specialties - Institute of Obstetrics and Ginecology, University of Catania, Catania, Italy
| | - Giovanni Carlo Ettorre
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
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18
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Abstract
Hydrocoele of the canal of Nuck is a rare condition in adult women caused by a failure of complete obliteration of the canal of Nuck. It may be likened to a patent processus vaginalis in men. In most cases, the diagnosis is made during surgery as it is often mistaken for an inguinal hernia. We report a case where the diagnosis of this condition was made preoperatively on imaging. The salient anatomy, clinical features, radiological images and surgical management are discussed and the medical literature reviewed.
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Affiliation(s)
- Qi Hui Bernice Heng
- Endocrine Surgical Service, Department of Surgery, Khoo Teck Puat Hospital, Singapore
| | - Dinesh Chinchure
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore
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Bazot M, Daraï E. Diagnosis of deep endometriosis: clinical examination, ultrasonography, magnetic resonance imaging, and other techniques. Fertil Steril 2017; 108:886-894. [DOI: 10.1016/j.fertnstert.2017.10.026] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 10/19/2017] [Accepted: 10/19/2017] [Indexed: 12/16/2022]
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Gui B, Valentini AL, Ninivaggi V, Miccò M, Zecchi V, Grimaldi PP, Cambi F, Guido M, Bonomo L. Shining light in a dark landscape: MRI evaluation of unusual localization of endometriosis. Diagn Interv Radiol 2017; 23:272-281. [PMID: 28703103 PMCID: PMC5508950 DOI: 10.5152/dir.2017.16364] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 01/31/2017] [Accepted: 02/04/2017] [Indexed: 01/07/2023]
Abstract
Endometriosis is a disease distinguished by the presence of endometrial tissue outside the uterine cavity with intralesional recurrent bleeding and resulting fibrosis. The most common locations for endometriosis are the ovaries, pelvic peritoneum, uterosacral ligaments, and torus uterinus. Typical symptoms are secondary dysmenorrhea and cyclic or chronic pelvic pain. Unusual sites of endometriosis may be associated with specific symptoms depending on the localization. Atypical pelvic endometriosis localizations can occur in the cervix, vagina, round ligaments, ureter, and nerves. Moreover, rare extrapelvic endometriosis implants can be localized in the upper abdomen, subphrenic fold, or in the abdominal wall. Magnetic resonance imaging (MRI) represents a problem-solving tool among other imaging modalities. MRI is an advantageous technique, because of its multiplanarity, high contrast resolution, and lack of ionizing radiation. Our purpose is to remind the radiologists the possibility of atypical pelvic and extrapelvic endometriosis localizations and to illustrate the specific MRI findings. Endometriotic tissue with hemorrhagic content can be distinguished from adherences and fibrosis on MRI imaging. Radiologists should keep in mind these atypical localizations in patients with suspected endometriosis, in order to achieve the diagnosis and to help the clinicians in planning a correct and complete treatment strategy.
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Affiliation(s)
- Benedetta Gui
- From the Institute of Radiology, Diagnostic Area (B.G. , A.L.V., V.N., M.M., V.Z., P.P.G., F.C., L.B.) and the Institute of Obstetrics and Gynecology, Female Health Area (M.G.), Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy; “F. Miulli” Regional General Hospital (M.G.), Acquaviva delle Fonti, Bari, Italy
| | - Anna Lia Valentini
- From the Institute of Radiology, Diagnostic Area (B.G. , A.L.V., V.N., M.M., V.Z., P.P.G., F.C., L.B.) and the Institute of Obstetrics and Gynecology, Female Health Area (M.G.), Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy; “F. Miulli” Regional General Hospital (M.G.), Acquaviva delle Fonti, Bari, Italy
| | - Valeria Ninivaggi
- From the Institute of Radiology, Diagnostic Area (B.G. , A.L.V., V.N., M.M., V.Z., P.P.G., F.C., L.B.) and the Institute of Obstetrics and Gynecology, Female Health Area (M.G.), Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy; “F. Miulli” Regional General Hospital (M.G.), Acquaviva delle Fonti, Bari, Italy
| | - Maura Miccò
- From the Institute of Radiology, Diagnostic Area (B.G. , A.L.V., V.N., M.M., V.Z., P.P.G., F.C., L.B.) and the Institute of Obstetrics and Gynecology, Female Health Area (M.G.), Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy; “F. Miulli” Regional General Hospital (M.G.), Acquaviva delle Fonti, Bari, Italy
| | - Viola Zecchi
- From the Institute of Radiology, Diagnostic Area (B.G. , A.L.V., V.N., M.M., V.Z., P.P.G., F.C., L.B.) and the Institute of Obstetrics and Gynecology, Female Health Area (M.G.), Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy; “F. Miulli” Regional General Hospital (M.G.), Acquaviva delle Fonti, Bari, Italy
| | - Pier Paolo Grimaldi
- From the Institute of Radiology, Diagnostic Area (B.G. , A.L.V., V.N., M.M., V.Z., P.P.G., F.C., L.B.) and the Institute of Obstetrics and Gynecology, Female Health Area (M.G.), Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy; “F. Miulli” Regional General Hospital (M.G.), Acquaviva delle Fonti, Bari, Italy
| | - Francesco Cambi
- From the Institute of Radiology, Diagnostic Area (B.G. , A.L.V., V.N., M.M., V.Z., P.P.G., F.C., L.B.) and the Institute of Obstetrics and Gynecology, Female Health Area (M.G.), Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy; “F. Miulli” Regional General Hospital (M.G.), Acquaviva delle Fonti, Bari, Italy
| | - Maurizio Guido
- From the Institute of Radiology, Diagnostic Area (B.G. , A.L.V., V.N., M.M., V.Z., P.P.G., F.C., L.B.) and the Institute of Obstetrics and Gynecology, Female Health Area (M.G.), Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy; “F. Miulli” Regional General Hospital (M.G.), Acquaviva delle Fonti, Bari, Italy
| | - Lorenzo Bonomo
- From the Institute of Radiology, Diagnostic Area (B.G. , A.L.V., V.N., M.M., V.Z., P.P.G., F.C., L.B.) and the Institute of Obstetrics and Gynecology, Female Health Area (M.G.), Catholic University of the Sacred Heart, Agostino Gemelli Hospital, Rome, Italy; “F. Miulli” Regional General Hospital (M.G.), Acquaviva delle Fonti, Bari, Italy
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Bourgioti C, Preza O, Panourgias E, Chatoupis K, Antoniou A, Nikolaidou ME, Moulopoulos LA. MR imaging of endometriosis: Spectrum of disease. Diagn Interv Imaging 2017; 98:751-767. [PMID: 28652096 DOI: 10.1016/j.diii.2017.05.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 05/22/2017] [Accepted: 05/28/2017] [Indexed: 02/07/2023]
Abstract
Endometriosis is a common gynecological disorder defined by the presence of endometrial tissue outside the uterus. It is the most common cause of chronic pelvic pain and typically affects the ovaries, uterine ligaments, peritoneum, tubes, rectovaginal septum and bladder. It may, however, be found at various extrapelvic sites, including the perineum, liver, pancreas, lung or even the central nervous system, and in such cases, diagnosis may be quite challenging. Even though definitive diagnosis requires laparoscopy, preoperative identification of endometriosis is important not only to differentiate it from other diseases with similar clinical presentations but also, for accurate presurgical mapping, since complete removal of all endometriotic foci is critical for the effective treatment of the patient's symptoms. Ultrasound is performed initially, but magnetic resonance imaging (MRI) is increasingly being used, particularly when sonographic findings are unclear, when deep pelvic endometriosis is suspected or when surgery is planned, as it provides better contrast resolution and a larger field of view compared to ultrasound. In this article, we will discuss distinctive MRI appearances of endometriotic foci and we will review common and uncommon locations of endometriosis within the body, in an attempt to familiarize radiologists with its wide spectrum of manifestations.
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Affiliation(s)
- C Bourgioti
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion hospital, 76, Vassilisis-Sofias Ave., 11528 Athens, Greece.
| | - O Preza
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion hospital, 76, Vassilisis-Sofias Ave., 11528 Athens, Greece.
| | - E Panourgias
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion hospital, 76, Vassilisis-Sofias Ave., 11528 Athens, Greece.
| | - K Chatoupis
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion hospital, 76, Vassilisis-Sofias Ave., 11528 Athens, Greece.
| | - A Antoniou
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion hospital, 76, Vassilisis-Sofias Ave., 11528 Athens, Greece.
| | - M E Nikolaidou
- Department of Gynaecology and Obstetrics, Rea maternity hospital, 383, Sygrou Ave., 17564 Athens, Greece.
| | - L A Moulopoulos
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion hospital, 76, Vassilisis-Sofias Ave., 11528 Athens, Greece.
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24
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Méndez Fernández R, Barrera Ortega J. Magnetic resonance imaging of pelvic endometriosis. RADIOLOGIA 2017; 59:286-296. [PMID: 28476282 DOI: 10.1016/j.rx.2017.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 02/04/2017] [Accepted: 02/16/2017] [Indexed: 12/26/2022]
Abstract
Endometriosis is common in women of reproductive age; it can cause pelvic pain and infertility. It is important to diagnose endometriosis and to thoroughly evaluate its extension, especially when surgical treatment is being considered. Magnetic resonance imaging (MRI) with careful examination technique and interpretation enables more accurate and complete diagnosis and staging than ultrasonography, especially in cases of deep pelvic endometriosis. Furthermore, MRI can identify implants in sites that can be difficult to access in endoscopic or laparoscopic explorations. In this article, we describe the appropriate MRI protocol for the study of pelvic endometriosis and the MRI signs of pelvic organ involvement. It is necessary to know the subtle findings and to look for them so we can ensure that they are not overlooked. We describe clinical grading systems for endometriosis and review the diagnostic efficacy of MRI in comparison with other imaging techniques and surgery.
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Affiliation(s)
- R Méndez Fernández
- Servicio de Radiodiagnóstico. Hospital Clínico San Carlos y RM N.ª Sra. del Rosario, Madrid, España.
| | - J Barrera Ortega
- Servicio de Radiodiagnóstico. Hospital Clínico San Carlos y RM N.ª Sra. del Rosario, Madrid, España
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25
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Abstract
Premenopausal women with acute pelvic pain comprise a significant percentage of patients who present to the emergency room. Etiologies can be gynecologic, urologic, gastrointestinal, or vascular. Signs and symptoms are often nonspecific and overlapping. The choice of imaging modality is determined by the clinically suspected differential diagnosis. Ultrasound (US) is the preferred imaging modality for suspected obstetric or gynecologic disorders. CT is more useful when gastrointestinal or urinary tract pathology is likely. MR imaging is rarely used in the emergent setting, except to exclude appendicitis in pregnant women. This article presents a comprehensive review of imaging of acute gynecologic disorders.
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Affiliation(s)
- Carolyn K Donaldson
- Department of Radiology, NorthShore University HealthSystem, 2650 Ridge Avenue, Evanston, IL 60201, USA.
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26
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Pandey D, Coondoo A, Shetty J, Mathew S. Jack in the box: inguinal endometriosis. BMJ Case Rep 2015; 2015:bcr-2014-207988. [PMID: 25827916 DOI: 10.1136/bcr-2014-207988] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
A 39-year-old woman with a left-sided inguinal swelling was referred to us with a diagnosis of inguinal hernia. On asking leading questions, the patient gave a typical history of cyclical pain and increased swelling during menstruation. Fine-needle aspiration biopsy revealed endometrial glands. Preoperatively, the extent of the endometriotic lesion was delineated using MRI. The lesion was approached through the patient's caesarean scar for cosmetic reasons and excised in toto. Final diagnosis was round ligament endometriosis. The patient was asymptomatic at 3, 6 and 12 months' follow-up. This case re-emphasises the fact that endometriosis is an enigmatic disease and can be found anywhere in the body. Thus, a woman of reproductive age presenting with any cyclical symptom should be asked about its relation to her menstrual cycle.
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Affiliation(s)
- Deeksha Pandey
- Department of OBGYN, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Ambika Coondoo
- Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Jyothi Shetty
- Department of OBGYN, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Stanley Mathew
- Department of Surgery, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
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27
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Kołodziejczak M, Sudoł-Szopińska I, Santoro GA, Bielecki K, Wiączek A. Ultrasonographic evaluation of anal endometriosis: report of four cases. Tech Coloproctol 2014; 18:1099-104. [PMID: 24915940 DOI: 10.1007/s10151-014-1176-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Accepted: 05/30/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND The presence of endometriosis in the anal canal and perianal tissues is rare and difficult to suspect at clinical examination. We report our experience with preoperative ultrasound evaluation of four cases of anal endometriosis. METHODS Four patients were evaluated by transperineal and high-resolution three-dimensional endoanal ultrasonography. RESULTS In 3 of 4 women, the lesions involved old episiotomy scars. Anal endometriosis appeared as hypoechoic cystic lesions with areas of microcalcification, not well delimited and highly vascularized. The lesions either involved the anal sphincter (n = 2, one within the rectovaginal septum) or were localized superficially in the ischiorectal space (n = 2). Surgery and pathologic exam confirmed the ultrasonographic findings. CONCLUSIONS Ultrasonographic findings of anal endometriosis are characteristics and may allow accurate preoperative staging of the disease.
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Affiliation(s)
- M Kołodziejczak
- Department of General Surgery, Sub-Department of Proctology, Hospital at Solec, 00-382, Warsaw, Poland
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