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Duraffourg M, Rougereau G, Fawaz R, Ltaief A, Jacquesson T, Freydier M, Baude C, Robert R, Mertens P. Lumbosacral plexus and pudendal nerve magnetic resonance tractography: A systematic review of the clinical applications for pudendal neuralgia. Magn Reson Imaging 2024; 112:18-26. [PMID: 38797289 DOI: 10.1016/j.mri.2024.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/18/2024] [Accepted: 05/22/2024] [Indexed: 05/29/2024]
Abstract
Diffusion tensor imaging (DTI) is commonly used to establish three-dimensional mapping of white-matter bundles in the supraspinal central nervous system. DTI has also been the subject of many studies on cranial and peripheral nerves. This non-invasive imaging technique enables virtual dissection of nerves in vivo and provides specific measurements of microstructural integrity. Adverse effects on the lumbosacral plexus may be traumatic, compressive, tumoral, or malformative and thus require dedicated treatment. DTI could lead to new perspectives in pudendal neuralgia diagnosis and management. We performed a systematic review of all articles or posters reporting results and protocols for lumbosacral plexus mapping using the DTI technique between January 2011 and December 2023. Twenty-nine articles published were included. Ten studies with a total of 351 participants were able to track the lumbosacral plexus in a physiological context and 19 studies with a total of 402 subjects tracked lumbosacral plexus in a pathological context. Tractography was performed on a 1.5T or 3T MRI system. DTI applied to the lumbosacral plexus and pudendal nerve is feasible but no microstructural normative value has been proposed for the pudendal nerve. The most frequently tracking parameters used in our review are: 3T MRI, b-value of 800 s/mm2, 33 directions, 3 × 3 × 3 mm3, AF threshold of 0.1, minimum fiber length of 10 mm, bending angle of 30°, and 3DT2 TSE anatomical resolution. Increased use of DTI could lead to new perspectives in the management of pudendal neuralgia due to entrapment syndrome, whether at the diagnostic, prognostic, or preoperative planning level. Prospective studies of healthy subjects and patients with the optimal acquisition parameters described above are needed to establish the accuracy of MR tractography for diagnosing pudendal neuralgia and other intrapelvic nerve entrapments.
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Affiliation(s)
- M Duraffourg
- Unité de Neuromodulation Polyvalente, Service de Neurochirurgie fonctionnelle de la moelle et des nerfs périphériques - Hospices Civils de Lyon, Hôpital neurologique et neurochirurgical Pierre Wertheimer, Bron, France; Centre d'Évaluation et de Traitement de la Douleur, Hospices Civils de Lyon- Hôpital neurologique et neurochirurgical Pierre Wertheimer, Bron, France
| | - G Rougereau
- Service de chirurgie orthopédique et traumatologique Hôpital Pitié Salpetrière, Paris, France
| | - R Fawaz
- Unité de Neuromodulation Polyvalente, Service de Neurochirurgie fonctionnelle de la moelle et des nerfs périphériques - Hospices Civils de Lyon, Hôpital neurologique et neurochirurgical Pierre Wertheimer, Bron, France; Centre d'Évaluation et de Traitement de la Douleur, Hospices Civils de Lyon- Hôpital neurologique et neurochirurgical Pierre Wertheimer, Bron, France; Service de Neurochirurgie - Hôpital d'Instruction des Armées Percy, Clamart, France.
| | - A Ltaief
- Service d'imagerie médicale et interventionnelle - Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - T Jacquesson
- Service de Neurochirurgie crânienne générale, tumorale et vasculaire - Hospices Civils de Lyon- Hôpital neurologique et neurochirurgical Pierre Wertheimer, Bron, France; Faculté de Médecine Lyon Est, Université Claude Bernard, Lyon, France
| | - M Freydier
- Centre d'Évaluation et de Traitement de la Douleur - Centre Hospitalier de Macon, Macon, France; Centre d'Évaluation et de Traitement de la Douleur - Médipôle Hôpital Mutualiste, Villeurbanne, France
| | - C Baude
- Centre d'Évaluation et de Traitement de la Douleur - Médipôle Hôpital Mutualiste, Villeurbanne, France
| | - R Robert
- Service de chirurgie - Hôpital Privé du Confluent, Nantes, France; Faculté de Médecine de Nantes, Nantes, France
| | - P Mertens
- Unité de Neuromodulation Polyvalente, Service de Neurochirurgie fonctionnelle de la moelle et des nerfs périphériques - Hospices Civils de Lyon, Hôpital neurologique et neurochirurgical Pierre Wertheimer, Bron, France; Centre d'Évaluation et de Traitement de la Douleur, Hospices Civils de Lyon- Hôpital neurologique et neurochirurgical Pierre Wertheimer, Bron, France; Faculté de Médecine Lyon Est, Université Claude Bernard, Lyon, France
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Colak C, Chamie LP, Youngner J, Forney MC, Luna Russo MA, Gubbels A, VanBuren WM, Feldman M. MRI Features of Pelvic Nerve Involvement in Endometriosis. Radiographics 2024; 44:e230106. [PMID: 38170677 DOI: 10.1148/rg.230106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Endometriosis is a common condition that mostly affects people assigned as female at birth. The most common clinical symptom of endometriosis is pain. Although the mechanism for this pain is poorly understood, in some cases, the nerves are directly involved in endometriosis. Endometriosis is a multifocal disease, and the pelvis is the most common location involved. Nerves in the pelvis can become entrapped and involved in endometriosis. Pelvic nerves are visible at pelvic MRI, especially when imaging planes and sequences are tailored for neural evaluation. In particular, high-spatial-resolution anatomic imaging including three-dimensional isotropic imaging and contrast-enhanced three-dimensional short inversion time inversion-recovery (STIR) fast spin-echo sequences are useful for nerve imaging. The most commonly involved nerves are the sciatic, obturator, femoral, pudendal, and inferior hypogastric nerves and the inferior hypogastric and lumbosacral plexuses. Although it is thought to be rare, the true incidence of nerve involvement in endometriosis is not known. Symptoms of neural involvement include pain, weakness, numbness, incontinence, and paraplegia and may be constant or cyclic (catamenial). Early diagnosis of neural involvement in endometriosis is important to prevent irreversible nerve damage and chronic sensorimotor neuropathy. Evidence of irreversible damage can also be seen at MRI, and radiologists should evaluate pelvic nerves that are commonly involved in endometriosis in their search pattern and report template to ensure that this information is incorporated into treatment planning.
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Affiliation(s)
- Ceylan Colak
- From the Imaging Institute (C.C., J.Y., M.C.F.), Department of Obstetrics and Gynecology, OBGYN and Women's Health Institute (M.A.L.R.), and Subspecialty Care for Women's Health (A.G., M.F.), Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195; Department of Diagnostic Imaging, Fleury Medicina e Saúde, São Paulo, Brazil (L.P.C.); and Department of Radiology, Mayo Clinic, Rochester, Minn (W.M.V.)
| | - Luciana P Chamie
- From the Imaging Institute (C.C., J.Y., M.C.F.), Department of Obstetrics and Gynecology, OBGYN and Women's Health Institute (M.A.L.R.), and Subspecialty Care for Women's Health (A.G., M.F.), Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195; Department of Diagnostic Imaging, Fleury Medicina e Saúde, São Paulo, Brazil (L.P.C.); and Department of Radiology, Mayo Clinic, Rochester, Minn (W.M.V.)
| | - Jonathan Youngner
- From the Imaging Institute (C.C., J.Y., M.C.F.), Department of Obstetrics and Gynecology, OBGYN and Women's Health Institute (M.A.L.R.), and Subspecialty Care for Women's Health (A.G., M.F.), Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195; Department of Diagnostic Imaging, Fleury Medicina e Saúde, São Paulo, Brazil (L.P.C.); and Department of Radiology, Mayo Clinic, Rochester, Minn (W.M.V.)
| | - Michael C Forney
- From the Imaging Institute (C.C., J.Y., M.C.F.), Department of Obstetrics and Gynecology, OBGYN and Women's Health Institute (M.A.L.R.), and Subspecialty Care for Women's Health (A.G., M.F.), Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195; Department of Diagnostic Imaging, Fleury Medicina e Saúde, São Paulo, Brazil (L.P.C.); and Department of Radiology, Mayo Clinic, Rochester, Minn (W.M.V.)
| | - Miguel A Luna Russo
- From the Imaging Institute (C.C., J.Y., M.C.F.), Department of Obstetrics and Gynecology, OBGYN and Women's Health Institute (M.A.L.R.), and Subspecialty Care for Women's Health (A.G., M.F.), Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195; Department of Diagnostic Imaging, Fleury Medicina e Saúde, São Paulo, Brazil (L.P.C.); and Department of Radiology, Mayo Clinic, Rochester, Minn (W.M.V.)
| | - Ashley Gubbels
- From the Imaging Institute (C.C., J.Y., M.C.F.), Department of Obstetrics and Gynecology, OBGYN and Women's Health Institute (M.A.L.R.), and Subspecialty Care for Women's Health (A.G., M.F.), Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195; Department of Diagnostic Imaging, Fleury Medicina e Saúde, São Paulo, Brazil (L.P.C.); and Department of Radiology, Mayo Clinic, Rochester, Minn (W.M.V.)
| | - Wendaline M VanBuren
- From the Imaging Institute (C.C., J.Y., M.C.F.), Department of Obstetrics and Gynecology, OBGYN and Women's Health Institute (M.A.L.R.), and Subspecialty Care for Women's Health (A.G., M.F.), Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195; Department of Diagnostic Imaging, Fleury Medicina e Saúde, São Paulo, Brazil (L.P.C.); and Department of Radiology, Mayo Clinic, Rochester, Minn (W.M.V.)
| | - Myra Feldman
- From the Imaging Institute (C.C., J.Y., M.C.F.), Department of Obstetrics and Gynecology, OBGYN and Women's Health Institute (M.A.L.R.), and Subspecialty Care for Women's Health (A.G., M.F.), Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195; Department of Diagnostic Imaging, Fleury Medicina e Saúde, São Paulo, Brazil (L.P.C.); and Department of Radiology, Mayo Clinic, Rochester, Minn (W.M.V.)
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Bonde A, Andreazza Dal Lago E, Foster B, Javadi S, Palmquist S, Bhosale P. Utility of the Diffusion Weighted Sequence in Gynecological Imaging: Review Article. Cancers (Basel) 2022; 14:cancers14184468. [PMID: 36139628 PMCID: PMC9496793 DOI: 10.3390/cancers14184468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/30/2022] [Accepted: 09/08/2022] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Diffusion weighted imaging (DWI) is a magnetic resonance imaging sequence with diverse clinical applications in malignant and nonmalignant gynecological conditions. It provides vital supplemental information in the diagnosis and management of various gynecological conditions. Radiologists should be aware of fundamental concepts, clinical applications and pitfalls of DWI. Additionally we briefly discuss potential scope of newer advanced techniques based on DWI including diffusion tensor imaging and diffusion-weighted whole-body imaging with background signal suppression. Abstract Functional imaging with diffusion-weighted imaging (DWI) is a complementary tool to conventional diagnostic magnetic resonance imaging sequences. It is being increasingly investigated to predict tumor response and assess tumor recurrence. We elucidate the specific technical modifications of DWI preferred for gynecological imaging, including the different b-values and planes for image acquisition. Additionally, we discuss the problems and potential pitfalls encountered during DWI interpretation and ways to overcome them. DWI has a wide range of clinical applications in malignant and non-malignant gynecological conditions. It provides supplemental information helpful in diagnosing and managing tubo-ovarian abscess, uterine fibroids, endometriosis, adnexal torsion, and dermoid. Similarly, DWI has diverse applications in gynecological oncology in diagnosis, staging, detection of recurrent disease, and tumor response assessment. Quantitative evaluation with apparent diffusion coefficient (ADC) measurement is being increasingly evaluated for correlation with various tumor parameters in managing gynecological malignancies aiding in preoperative treatment planning. Newer advanced DWI techniques of diffusion tensor imaging (DTI) and whole body DWI with background suppression (DWIBS) and their potential uses in pelvic nerve mapping, preoperative planning, and fertility-preserving surgeries are briefly discussed.
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Affiliation(s)
- Apurva Bonde
- Department of Radiology, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
- Correspondence:
| | | | - Bryan Foster
- Department of Radiology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Sanaz Javadi
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Sarah Palmquist
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Priya Bhosale
- Department of Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Di Paola V, Perillo F, Gui B, Russo L, Pierconti F, Fiorentino V, Autorino R, Ferrandina G, Valentini V, Scambia G, Manfredi R. Detection of parametrial invasion in women with uterine cervical cancer using diffusion tensor imaging at 1.5T MRI. Diagn Interv Imaging 2022; 103:472-478. [DOI: 10.1016/j.diii.2022.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 01/02/2023]
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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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Vigueras Smith A, Cabrera R, Trippia C, Tessman Zomer M, Kondo W, Ferreira H, Carttaxo Da Silva L, Sumak R. Indirect and atypical imaging signals of endometriosis: A wide range of manifestations. Facts Views Vis Obgyn 2021; 13:339-356. [PMID: 35026096 PMCID: PMC9148709 DOI: 10.52054/fvvo.13.4.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Whilst some imaging signs of endometriosis are common and widely accepted as ‘typical’, a range of ‘subtle’ signs could be present in imaging studies, presenting an opportunity to the radiologist and the surgeon to aid the diagnosis and facilitate preoperative surgical planning. Objective To summarise and analyse the current information related to indirect and atypical signs of endometriosis by ultrasound (US) and magnetic resonance imaging (MRI). Methods Through the use of PubMed and Google scholar, we conducted a comprehensive review of available articles related to the diagnosis of indirect signs in transvaginal US and MRI. All abstracts were assessed and the studies were finally selected by two authors. Results Transvaginal US is a real time dynamic exploration, that can reach a sensitivity of 79-94% and specificity of 94%. It allows evaluation of normal sliding between structures in different compartments, searching for adhesions or fibrosis. MRI is an excellent tool that can reach a sensitivity of 94% and specificity of 77% and allows visualisation of the uterus, bowel loop deviation and peritoneal inclusion cysts. It also allows the categorisation and classification of ovarian cysts, rectovaginal and vesicovaginal septum obliteration, and small bowel endometriotic implants. Conclusion The use of an adequate mapping protocol with systematic evaluation and the reporting of direct and indirect signs of endometriosis is crucial for detailed and safe surgical planning.
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Effects of Breastfeeding on Endometriosis-Related Pain: A Prospective Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010602. [PMID: 34682348 PMCID: PMC8535640 DOI: 10.3390/ijerph182010602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/05/2021] [Accepted: 10/07/2021] [Indexed: 01/01/2023]
Abstract
Endometriosis is a gynecological estrogen-dependent disease whose commonest pain symptoms are dysmenorrhea, dyspareunia, and acyclic chronic pelvic pain (CPP). Hormonal changes occurring during breastfeeding seem to reduce pain and disease recurrence. The aim of this observational prospective study was to assess the effect of breastfeeding on pain and endometriotic lesions in patients with endometriosis and to evaluate a possible correlation between the duration of breastfeeding, postpartum amenorrhea, and pain. Out of 156 pregnant women with endometriosis enrolled, 123 who breastfed were included in the study and were monitored for 2 years after delivery; 96/123 exclusively breastfed for at least 1 month. Mode of delivery, type and duration of breastfeeding, intensity of pain symptoms, and lesion size before pregnancy and during the 24-month follow-up were analyzed. All patients experienced a significant reduction in dysmenorrhea proportional to the duration of breastfeeding. CPP was significantly reduced only in women who exclusively breastfed. No significant improvement in dyspareunia was observed. Ovarian endometriomas were significantly reduced. Therefore, breastfeeding, particularly if exclusive, may cause improvement in dysmenorrhea and CPP proportional to the duration of breastfeeding, as well as a reduction in the size of ovarian endometriomas.
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Can New ENZIAN Score 2020 Represent a Staging System Improving MRI Structured Report? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18199949. [PMID: 34639248 PMCID: PMC8508493 DOI: 10.3390/ijerph18199949] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/17/2021] [Accepted: 09/19/2021] [Indexed: 11/17/2022]
Abstract
Structured reporting systems for endometriotic disease are gaining a central role in diagnostic imaging: our aim is to evaluate applicability and the feasibility of the recent ENZIAN score (2020) assessed by MRI. A total of 60 patients with suspected tubo–ovarian/deep endometriosis were retrospectively included in our study according to the following criteria: availability of MR examination; histopathological results from laparoscopic or surgical treatment; patients were not assuming estro-progestin or progestin therapy. Three different readers (radiologists with 2-, 5-, and 20-years of experience in pelvic imaging) have separately assigned a score according to the ENZIAN score (revised 2020) for all lesions detected by magnetic resonance imaging (MRI). Our study showed a high interobserver agreement and feasibility of the recent ENZIAN score applied to MRI; on the other hand, our experience highlighted some limitations mainly due to MRI’s inability to assess tubal patency and mobility, as required by the recent score (2020). In view of the limitations which arose from our study, we propose a modified MRI-ENZIAN score that provides a complete structured reporting system, more suitable for MRI. The high interobserver agreement of the recent ENZIAN score applied to MRI confirms its validity as a complete staging system for endometriosis, offering a shared language between radiologists and surgeons.
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Pashkunova-Martic I, Manzano-Szalai K, Friske J, Aszmann O, Theiner S, Klose MHM, Baurecht D, Trattnig S, Keppler BK, Helbich TH. Modified amino-dextrans as carriers of Gd-chelates for retrograde transport and visualization of peripheral nerves by magnetic resonance imaging (MRI). J Inorg Biochem 2021; 222:111495. [PMID: 34098348 DOI: 10.1016/j.jinorgbio.2021.111495] [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: 02/10/2021] [Revised: 04/22/2021] [Accepted: 05/25/2021] [Indexed: 11/21/2022]
Abstract
Amino-dextrans (AD) conjugated with gadolinium (Gd3+) were developed as neuro-specific contrast agents (CA) for the visualization of the sciatic nerve in rats by magnetic resonance imaging (MRI). AD with 3, 10, and 70 kDa molecular weights were assessed as carrier molecules known to be transported with various speed by axonal microtubules. Detailed spectroscopic characterizations, analyses by Fast Protein Liquid Chromatography (FPLC), Sodium Dodecyl Sulfate Polyacrylamide Gel Electrophoresis (SDS-PAGE), and inductively coupled plasma-mass spectrometry (ICP-MS), were carried out. For MRI, the paramagnetic Gd3+ ion was coupled as a T1 signal enhancer. The well-established linear chelator, diethylenetriaminepentaacetic acid (DTPA), was used and subsequently replaced by the more stable cyclic chelator 1,4,7,10-Tetraazacyclododecane-1,4,7,10-tetraacetic acid (DOTA). In addition, a fluorescently labeled AD-DTPA-Gd was prepared to demonstrate an active transport to the spinal cord by histochemistry. After successful synthesis and characterization, molecular migration of the AD-DTPA-Gd in the sciatic nerve of healthy Sprague Dawley rats was monitored by MRI for up to seven days. Enhancement of nerve structures was evaluated by MRI and correlated with ICP-MS analyses. To investigate the distribution of CA along the neuraxis, all animals were sacrificed after the final MRI monitoring. Nerves, spinal ganglions, and corresponding spinal cord sections were harvested, to determine the localization and concentration of the paramagnetic element. This is the first report that demonstrates the active uptake and transport of AD-Gd conjugates within the sciatic nerve. This new concept may serve as a potential diagnostic tool for the direct visualization and monitoring of the continuity of injured nerves.
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Affiliation(s)
- Irena Pashkunova-Martic
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Structural Preclinical Imaging, Medical University of Vienna & General Hospital of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; Institute of Inorganic Chemistry, Faculty of Chemistry, University of Vienna, Waehringer Strasse 42, 1090 Vienna, Austria.
| | - Krisztina Manzano-Szalai
- Department of Surgery, Division of Plastic & Reconstructive Surgery, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Joachim Friske
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Structural Preclinical Imaging, Medical University of Vienna & General Hospital of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; Department of Biomedical Imaging and Image-guided Therapy, High Field MR Center, Lazarettgasse 14, 1090 Vienna, Austria
| | - Oskar Aszmann
- Department of Surgery, Division of Plastic & Reconstructive Surgery, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Sarah Theiner
- Institute of Analytical Chemistry, Faculty of Chemistry, University of Vienna, Waehringer Strasse 38, 1090 Vienna, Austria; Institute of Inorganic Chemistry, Faculty of Chemistry, University of Vienna, Waehringer Strasse 42, 1090 Vienna, Austria
| | - Matthias H M Klose
- Institute of Analytical Chemistry, Faculty of Chemistry, University of Vienna, Waehringer Strasse 38, 1090 Vienna, Austria
| | - Dieter Baurecht
- Department of Physical Chemistry, University of Vienna, Vienna, Austria
| | - Siegfried Trattnig
- Department of Biomedical Imaging and Image-guided Therapy, High Field MR Center, Lazarettgasse 14, 1090 Vienna, Austria
| | - Bernhard K Keppler
- Institute of Inorganic Chemistry, Faculty of Chemistry, University of Vienna, Waehringer Strasse 42, 1090 Vienna, Austria
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Structural Preclinical Imaging, Medical University of Vienna & General Hospital of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
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Jin H, Zheng L, Lu L, Cui M. Near-infrared intraoperative imaging of pelvic autonomic nerves: a pilot study. Surg Endosc 2021; 36:2349-2356. [PMID: 33909127 DOI: 10.1007/s00464-021-08512-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 04/17/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The pelvic autonomic nerves control and regulate anorectal and urogenital function. The dysfunction of pelvic autonomic nerves lead to disorders of anorectum, bladder and male sex organs. Thus the intraoperative identification of pelvic autonomic nerves could be crucial in complications prevention and diseases treatment. Our clinical trial aims at estimating the effectiveness and validity of intraoperative indocyanine green fluorescence imaging in pelvic autonomic nerves identification. METHODS Intraoperative fluorescence imaging using indocyanine green was performed in ten patients and the feasibility was determined. From February 2019 to June 2019, the seven patients undergoing laparoscopic colorectal resection was administrated 4.5 mg/Kg indocyanine green 24 h before surgery. The near-infrared fluorescence imaging was conducted during surgery. A novel white light and near-infrared dual-channel laparoscopic equipment was applied. For each patient, signal-background ratio values for pelvic autonomic nerves were recorded and analyzed. RESULTS We confirmed the dose and timing of indocyanine green administration was 4.5 mg/Kg and 24 h before surgery. Using the dual laparoscopic equipment, we could observe the splanchnic plexus, inferior mesenteric artery plexus, and sacral plexus successfully with a high signal background ratio value of 3.18 (standard deviation: 0.48). CONCLUSION This pilot trial shows feasibility of intraoperative indocyanine green fluorescence imaging in pelvic autonomic nerves observation. It demonstrates that nerves can be visualized using alternative imaging techniques but it is not ready yet for prime time. This technique might aid observation with white light alone. Registration number: ChiCTR1900025336.
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Affiliation(s)
- Hao Jin
- The Second Department of General Surgery, Zhuhai People's Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, Guangdong Province, 519000, China
| | - Li Zheng
- The Department of Clinical Laboratory, The Fifth People's Hospital of Zhuhai, Zhuhai, Guangdong Province, 519000, China
| | - Ligong Lu
- Zhuhai People's Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, Guangdong Province, 519000, China.
| | - Min Cui
- Zhuhai People's Hospital (Zhuhai Hospital Affiliated with Jinan University), Zhuhai, Guangdong Province, 519000, China.
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Masciullo L, Viscardi MF, Piacenti I, Scaramuzzino S, Cavalli A, Piccioni MG, Porpora MG. A deep insight into pelvic pain and endometriosis: a review of the literature from pathophysiology to clinical expressions. Minerva Obstet Gynecol 2021; 73:511-522. [PMID: 33904687 DOI: 10.23736/s2724-606x.21.04779-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Endometriosis is a chronic inflammatory disease that affects approximately 10% of women of reproductive age. Its clinical manifestations are highly heterogeneous, but pelvic pain is the most frequent, causing functional disability. Cyclic or acyclic chronic pelvic pain (CPP), dysmenorrhea and dyspareunia are frequent symptoms which often compromise all aspects of the women's quality of life (QoL). The pathophysiology of endometriosis-related pain is extremely complex and not always clear. The aim of this literature review is to focus on recent updates on the clinical presentation, the pathophysiology and the most important mechanisms involved in the pathogenesis of pelvic pain in endometriosis. A literature search in the Cochrane library, PubMed, Scopus and web of Science databases has been performed, identifying articles from January 1995 to November 2020. Several processes seem to be involved in the pathogenesis of pain, but many aspects are still unclear. Scientific evidence has shown that a correlation between pain severity and stage of endometriosis rarely occurs, whereas there is a significant correlation between pain and the presence of deep endometriosis. Onset and intensity of pain may be due to a complex process involving central sensitization and peripheral activation of nociceptive pathways as well as dysfunction of the immune system and of the hypothalamic-pituitary-adrenal (HPA) axis. A deeper understanding of these different pathogenetic mechanisms may improve future treatments in women with painful endometriosis.
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Affiliation(s)
- Luisa Masciullo
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Maria F Viscardi
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Ilaria Piacenti
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Sara Scaramuzzino
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Alessandra Cavalli
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Maria G Piccioni
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Maria G Porpora
- Department of Maternal and Child Health and Urological Sciences, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy -
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Celli V, Ciulla S, Dolciami M, Satta S, Ercolani G, Porpora MG, Catalano C, Manganaro L. Magnetic Resonance Imaging in endometriosis-associated pain. Minerva Obstet Gynecol 2021; 73:553-571. [PMID: 33904689 DOI: 10.23736/s2724-606x.21.04782-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Endometriosis affects 10%-15% of women in reproductive age and may cause no-cyclic chronic pelvic pain, dysmenorrhea, dyspareunia, urinary tract symptoms, and it is frequently associated with infertility. The peak of incidence is between 24 and 29 years old and the clinical diagnosis of endometriosis is generally delayed by 6-7 years. Laparoscopy with surgical biopsies is the "gold standard" for the diagnosis of endometriosis, with histological verification of endometrial ectopic glands and/or stroma. However, nowadays two different non-invasive modalities are routinely used for a presumptive diagnosis: Transvaginal Ultrasound (TVUS) and Magnetic Resonance Imaging (MRI). EVIDENCE ACQUISITION A structured search using PubMed was performed starting from October 2020 and including all relevant original and review articles published since 2000. The search used the following key word combinations: "Endometriosis MRI" AND "DIE and MRI" (45); "MRI endometriosis and Pelvic Pain" OR "Endometriosis and MRI technical development" (296). Ultimately, 87 articles were deemed relevant and used as the literature basis of this review. EVIDENCE SYNTHESIS TVUS represents the first imaging approach for endometriosis showing a good diagnostic performance but it is highly operator dependent. MRI is a second level examination often used in complex cases indeterminate after TVUS and in pre-operative planning. MRI is considered the best imaging technique for mapping endometriosis since it provides a more reliable map of deep infiltrating endometriosis than physical examination and transvaginal ultrasound. We have analyzed and described the main forms of endometriosis: adnexal endometriosis, adenomyosis, peritoneal implants and deep infiltrating endometriosis, showing their appearance in the two imaging modalities. CONCLUSIONS Endometriosis is one of the most common gynecologic disorders correlated to chronic pelvic pain whose treatment is still today complex and controversial. In this context, MRI has become an important additional non-invasive tool to investigate cases of chronic pelvic pain related to deep infiltrating endometriosis (DIE) with or without neural involvement.
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Affiliation(s)
- Veronica Celli
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy
| | - Sandra Ciulla
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy
| | - Miriam Dolciami
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy
| | - Serena Satta
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy
| | - Giada Ercolani
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy
| | - Maria G Porpora
- Department of Maternal and Child Health and Urological Sciences, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy
| | - Lucia Manganaro
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy - lucia.manganaro@uniroma1
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Yang S, Kwon S, Chang MC. The Usefulness of Diffusion Tensor Tractography in Diagnosing Neuropathic Pain: A Narrative Review. Front Neurosci 2021; 15:591018. [PMID: 33841069 PMCID: PMC8032899 DOI: 10.3389/fnins.2021.591018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 02/25/2021] [Indexed: 11/13/2022] Open
Abstract
Diffusion tensor tractography (DTT) is derived from diffusion tensor imaging. It has allowed visualization and estimation of neural tract injury, which may be associated with the pathogenesis of neuropathic pain (NP). The aim of the present study was to review DTT studies that demonstrated the relationship between neural injuries and NP and to describe the potential use of DTT in the evaluation of neural injuries that are involved in the pathophysiological process of NP. A PubMed search was conducted for articles published until July 3, 2020, which used DTT to investigate the association between neural injuries and NP. The key search phrase for identifying potentially relevant articles was (diffusion tensor tractography AND pain). The following inclusion criteria were applied for article selection: (1) studies involving patients with NP and (2) studies in which DTT was applied for the evaluation of NP. Review articles were excluded. Altogether, 108 potentially relevant articles were identified. After reading the titles and abstracts and assessment of eligibility based on the full-text articles, 46 publications were finally included in our review. The results of the included studies suggested that DTT may be beneficial in identifying the pathophysiological mechanism of NP of various origins including central pain caused by brain injuries, trigeminal neuralgia, sciatica, and some types of headache. Further studies are needed to validate the efficacy of DTT in investigating the pathophysiology of other types of NP.
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Affiliation(s)
- Seoyon Yang
- Department of Rehabilitation Medicine, Ewha Women's University Seoul Hospital, Ewha Women's University School of Medicine, Seoul, South Korea
| | - SuYeon Kwon
- Department of Rehabilitation Medicine, Ewha Women's University Seoul Hospital, Ewha Women's University School of Medicine, Seoul, South Korea
| | - Min Cheol Chang
- Department of Rehabilitation Medicine, College of Medicine, Yeungnam University, Daegu, South Korea
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Irimia A, Van Horn JD. Mapping the rest of the human connectome: Atlasing the spinal cord and peripheral nervous system. Neuroimage 2021; 225:117478. [PMID: 33160086 PMCID: PMC8485987 DOI: 10.1016/j.neuroimage.2020.117478] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 09/15/2020] [Accepted: 10/13/2020] [Indexed: 12/13/2022] Open
Abstract
The emergence of diffusion, structural, and functional neuroimaging methods has enabled major multi-site efforts to map the human connectome, which has heretofore been defined as containing all neural connections in the central nervous system (CNS). However, these efforts are not structured to examine the richness and complexity of the peripheral nervous system (PNS), which arguably forms the (neglected) rest of the connectome. Despite increasing interest in an atlas of the spinal cord (SC) and PNS which is simultaneously stereotactic, interactive, electronically dissectible, scalable, population-based and deformable, little attention has thus far been devoted to this task of critical importance. Nevertheless, the atlasing of these complete neural structures is essential for neurosurgical planning, neurological localization, and for mapping those components of the human connectome located outside of the CNS. Here we recommend a modification to the definition of the human connectome to include the SC and PNS, and argue for the creation of an inclusive atlas to complement current efforts to map the brain's human connectome, to enhance clinical education, and to assist progress in neuroscience research. In addition to providing a critical overview of existing neuroimaging techniques, image processing methodologies and algorithmic advances which can be combined for the creation of a full connectome atlas, we outline a blueprint for ultimately mapping the entire human nervous system and, thereby, for filling a critical gap in our scientific knowledge of neural connectivity.
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Affiliation(s)
- Andrei Irimia
- Ethel Percy Andrus Gerontology Center, Leonard Davis School of Gerontology, University of Southern California, 3715 McClintock Avenue, Los Angeles CA 90089, United States; Corwin D. Denney Research Center, Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, 1042 Downey Way, Los Angeles, CA 90089, United States.
| | - John Darrell Van Horn
- Department of Psychology, University of Virginia, 485 McCormick Road, Gilmer Hall, Room 102, Charlottesville, Virginia 22903, United States; School of Data Science, University of Virginia, Dell 1, Charlottesville, Virginia 22903, United States.
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15
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Gandhi J, Wilson AL, Liang R, Weissbart SJ, Khan SA. Sciatic endometriosis: A narrative review of an unusual neurogynecologic condition. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2020. [DOI: 10.1177/2284026520970813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Endometriosis is a condition in which there is an ectopic growth of endometrial tissue. Sciatic endometriosis, otherwise known as catamenial sciatica, is a rare but exceedingly significant presentation of endometriosis. Symptoms include cyclic sciatic pain that peaks during the menstrual period; additionally, paresthesia, paresis, and areflexia may occur with this condition. Sciatic endometriosis can be presumptively diagnosed in response to empiric treatment (e.g. gonadotropin-releasing hormone analogs) or imaging studies, but a definitive diagnosis of sciatic endometriosis may occur from examining tissue obtained during surgery. Surgical removal of endometriosis from the sciatic nerve root can potentially eliminate symptoms while maintaining normal reproductive function, though poses particular surgical risks. Familiarity with this rare condition is paramount to making this diagnosis and the initiation of earlier treatment.
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Affiliation(s)
- Jason Gandhi
- Department of Physiology and Biophysics, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
- Medical Student Research Institute, St. George’s University School of Medicine, Grenada, West Indies
| | - Anthony L Wilson
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Raymond Liang
- Department of Physiology and Biophysics, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Steven J Weissbart
- Department of Urology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
- Women’s Pelvic Health & Continence Center, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
| | - Sardar Ali Khan
- Department of Physiology and Biophysics, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
- Department of Urology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA
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16
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Wild M, Pandhi S, Rendle J, Swift I, Ofuasia E. MRI for the diagnosis and staging of deeply infiltrating endometriosis: a national survey of BSGE accredited endometriosis centres and review of the literature. Br J Radiol 2020; 93:20200690. [PMID: 32706984 DOI: 10.1259/bjr.20200690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Our objective was to establish the primary mode of imaging and MR protocols utilised in the preoperative staging of deeply infiltrating endometriosis in centres accredited by the British Society of Gynaecological Endoscopy (BSGE). METHODS The lead consultant radiologist in each centre was invited to complete an online survey detailing their protocols. RESULTS Out of 49 centres, 32 (65%) responded to the survey. Two centres performed transvaginal ultrasound as the primary method for preoperative staging of deeply infiltrating endometriosis and the remainder performed MRI. 21/25 centres did not recommend a period of fasting prior to MRI and 22/25 administered hyoscine butylbromide. None of the centres routinely offered bowel preparation or recommended a specific pre-procedure diet. 21/25 centres did not time imaging according to the woman's menstrual cycle, and instructions regarding bladder filling were varied. Rectal and vaginal opacification methods were infrequently utilised. All centres preferentially performed MRI in the supine position - six used an abdominal strap and four could facilitate prone imaging. Just under half of centres used pelvic-phased array coils and three centres used gadolinium contrast agents routinely. All centres performed T1W with fat-suppression and T2W without fat-suppression sequences. There was significant variation relating to other MR sequences depending on the unit. CONCLUSIONS There was significant inconsistency between centres in terms of MR protocols, patient preparation and the sequences performed. Many practices were out of line with current published evidence. ADVANCES IN KNOWLEDGE Our survey demonstrates a need for evidence-based standardisation of imaging in BSGE accredited endometriosis centres.
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Affiliation(s)
- Marianne Wild
- Department of Obstetrics and Gynaecology, Croydon University Hospital Endometriosis Centre 530 London Road , Croydon CR7 7YE, United Kingdom.,Department of Obstetrics and Gynaecology, Homerton University Hospital Endometriosis Centre Homerton Row , London E9 6DY, United Kingdom
| | - Shikha Pandhi
- Department of Radiology, Croydon University Hospital Endometriosis Centre 530 London Road, Croydon CR7 7YE, United Kingdom
| | - John Rendle
- Department of Radiology, Croydon University Hospital Endometriosis Centre 530 London Road, Croydon CR7 7YE, United Kingdom
| | - Ian Swift
- Department of Colorectal Surgery, Croydon University Hospital Endometriosis Centre 530 London Road , Croydon CR7 7YE, United Kingdom
| | - Emmanuel Ofuasia
- Department of Obstetrics and Gynaecology, Croydon University Hospital Endometriosis Centre 530 London Road , Croydon CR7 7YE, United Kingdom
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17
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Borghini R, Porpora MG, Casale R, Marino M, Palmieri E, Greco N, Donato G, Picarelli A. Irritable Bowel Syndrome-Like Disorders in Endometriosis: Prevalence of Nickel Sensitivity and Effects of a Low-Nickel Diet. An Open-Label Pilot Study. Nutrients 2020; 12:nu12020341. [PMID: 32012984 PMCID: PMC7071203 DOI: 10.3390/nu12020341] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 01/23/2020] [Accepted: 01/24/2020] [Indexed: 12/25/2022] Open
Abstract
Alimentary nickel (Ni) may result in allergic contact mucositis (ACM), whose prevalence is >30% and may present with IBS-like and extra-intestinal symptoms. These symptoms are also frequent in endometriosis, and Ni allergic contact dermatitis has already been observed in endometriosis. Therefore, intestinal and extra-intestinal symptoms in endometriosis may depend on a Ni ACM, and a low-Ni diet could improve symptoms. We studied the prevalence of Ni ACM in endometriosis and focused on the effects of a low-Ni diet on gastrointestinal, extra-intestinal, and gynecological symptoms. We recruited 84 women with endometriosis, symptomatic for gastrointestinal disorders. Thirty-one out of 84 patients completed the study. They underwent Ni oral mucosa patch test (omPT), questionnaire for intestinal/extra-intestinal/gynecological symptoms, and a low-Ni diet. Clinical evaluation was performed at baseline (T0) and after three months (T1). Twenty-eight out 31 (90.3%) patients showed Ni omPT positive results, with Ni ACM diagnosis, whereas three out of 31 (9.7%) patients showed negative Ni omPT. After three months of low-Ni diet, all gastrointestinal, extra-intestinal and gynecological symptoms showed a statistically significant reduction. Ni ACM has a high prevalence in endometriosis and a low-Ni diet may be recommended in this condition to reduce gastrointestinal, extra-intestinal and gynecological symptoms.
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Affiliation(s)
- Raffaele Borghini
- Department of Translational and Precision Medicine, Sapienza University, 155 00161 Rome, Italy; (R.B.); (R.C.); (M.M.); (N.G.)
| | - Maria Grazia Porpora
- Department of Gynecology, Obstetrics and Urology, Sapienza University, 155 00161 Rome, Italy; (M.G.P.); (E.P.); (G.D.)
| | - Rossella Casale
- Department of Translational and Precision Medicine, Sapienza University, 155 00161 Rome, Italy; (R.B.); (R.C.); (M.M.); (N.G.)
| | - Mariacatia Marino
- Department of Translational and Precision Medicine, Sapienza University, 155 00161 Rome, Italy; (R.B.); (R.C.); (M.M.); (N.G.)
| | - Emilia Palmieri
- Department of Gynecology, Obstetrics and Urology, Sapienza University, 155 00161 Rome, Italy; (M.G.P.); (E.P.); (G.D.)
| | - Nicoletta Greco
- Department of Translational and Precision Medicine, Sapienza University, 155 00161 Rome, Italy; (R.B.); (R.C.); (M.M.); (N.G.)
| | - Giuseppe Donato
- Department of Gynecology, Obstetrics and Urology, Sapienza University, 155 00161 Rome, Italy; (M.G.P.); (E.P.); (G.D.)
| | - Antonio Picarelli
- Department of Translational and Precision Medicine, Sapienza University, 155 00161 Rome, Italy; (R.B.); (R.C.); (M.M.); (N.G.)
- Correspondence: ; Tel.: +39-649970525; Fax: +39-64450219
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Extrapelvic Sciatic Nerve Endometriosis, the Role of Magnetic Resonance Imaging: Case Report and Systematic Review. J Comput Assist Tomogr 2019; 43:976-980. [PMID: 31688247 DOI: 10.1097/rct.0000000000000916] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Endometriosis (EN) is a common gynecological condition characterized by the presence of functional endometrium located outside the uterine cavity. Sciatic nerve (SN) is rarely affected by EN. Magnetic resonance imaging allows a direct visualization of the spinal and SN, and it is the modality of choice for the study of SN involvement in extrapelvic EN. We report a case of an endometrioma located in the right SN with a systematic review of the literature.
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Guerra A, Daraï E, Osório F, Setúbal A, Bendifallah S, Loureiro A, Thomassin-Naggara I. Imaging of postoperative endometriosis. Diagn Interv Imaging 2019; 100:607-618. [DOI: 10.1016/j.diii.2018.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/12/2018] [Accepted: 11/12/2018] [Indexed: 12/22/2022]
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Liu Z, Chen S, Qiu C, Sun Y, Li W, Jiang J, Zhang JM. Fractalkine/CX3CR1 Contributes to Endometriosis-Induced Neuropathic Pain and Mechanical Hypersensitivity in Rats. Front Cell Neurosci 2018; 12:495. [PMID: 30622457 PMCID: PMC6309014 DOI: 10.3389/fncel.2018.00495] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 12/03/2018] [Indexed: 11/13/2022] Open
Abstract
Pain is the most severe and common symptom of endometriosis. Its underlying pathogenetic mechanism is poorly understood. Nerve sensitization is a particular research challenge, due to the limitations of general endometriosis models and sampling nerve tissue from patients. The chemokine fractalkine (FKN) has been demonstrated to play a key role in various forms of neuropathic pain, while its role in endometriotic pain is unknown. Our study was designed to explore the function of FKN in the development and maintenance of peripheral hyperalgesia and central sensitization in endometriosis using a novel endometriosis animal model developed in our laboratory. After modeling, behavioral tests were carried out and the optimal time for molecular changes was obtained. We extracted ectopic tissues and L4-6 spinal cords to detect peripheral and central roles for FKN, respectively. To assess morphologic characteristics of endometriosis-like lesions-as well as expression and location of FKN/CX3CR1-we performed H&E staining, immunostaining, and western blotting analyses. Furthermore, inhibition of FKN expression in the spinal cord was achieved by intrathecal administration of an FKN-neutralizing antibody to demonstrate its function. Our results showed that implanted autologous uterine tissue around the sciatic nerve induced endometriosis-like lesions and produced mechanical hyperalgesia and allodynia. FKN was highly expressed on macrophages, whereas its receptor CX3CR1 was overexpressed in the myelin sheath of sciatic nerve fibers. Overexpressed FKN was also observed in neurons. CX3CR1/pp38-MAPK was upregulated in activated microglia in the spinal dorsal horn. Intrathecal administration of FKN-neutralizing antibody not only reversed the established mechanical hyperalgesia and allodynia, but also inhibited the expression of CX3CR1/pp38-MAPK in activated microglia, which was essential for the persistence of central sensitization. We concluded that the FKN/CX3CR1 signaling pathway might be one of the mechanisms of peripheral hyperalgesia in endometriosis, which requires further studies. Spinal FKN is important for the development and maintenance of central sensitization in endometriosis, and it may further serve as a novel therapeutic target to relieve persistent pain associated with endometriosis.
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Affiliation(s)
- Zhiming Liu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China.,Key Laboratory of Gynecologic Oncology of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
| | - Sisi Chen
- Pain Research Center, Department of Anesthesiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Chunping Qiu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China.,Key Laboratory of Gynecologic Oncology of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
| | - Yaqiong Sun
- Department of Obstetrics and Gynecology, Shandong Obstetrics and Gynecology Hospital, Jinan, China
| | - Wenzhi Li
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China.,Key Laboratory of Gynecologic Oncology of Shandong Province, Qilu Hospital of Shandong University, Jinan, China
| | - Jie Jiang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China
| | - Jun-Ming Zhang
- Pain Research Center, Department of Anesthesiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
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Bazot M, Bharwani N, Huchon C, Kinkel-Trugli K, Cunha TM, Guerra A, Manganaro L, Bunesch L, Kido A, Togashi K, Thomassin-Naggara I, Rockall A. Recommandations de la Société européenne d’imagerie génito-urinaire : IRM de l’endométriose pelvienne. IMAGERIE DE LA FEMME 2017. [DOI: 10.1016/j.femme.2017.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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22
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Porpora MG, Vinci V, De Vito C, Migliara G, Anastasi E, Ticino A, Resta S, Catalano C, Benedetti Panici P, Manganaro L. The Role of Magnetic Resonance Imaging-Diffusion Tensor Imaging in Predicting Pain Related to Endometriosis: A Preliminary Study. J Minim Invasive Gynecol 2017; 25:661-669. [PMID: 29126882 DOI: 10.1016/j.jmig.2017.10.033] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 10/24/2017] [Accepted: 10/29/2017] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To evaluate the sacral nerve root features by the means of magnetic resonance imaging-diffusion tensor imaging (MRI-DTI) tractography in women with endometriosis and/or adenomyosis, and to analyze the correlations among DTI abnormalities, pain symptoms, and endometriotic lesions found at surgery. DESIGN A cross-sectional, observational study (Canadian Task Force classification II-2). SETTING University hospital. PATIENTS Women (n = 76) with clinical suspicion of endometriosis. INTERVENTIONS Before surgery, dysmenorrhea, deep dyspareunia, and noncyclic pelvic pain (NCPP) were assessed using a 10-point visual analog scale. MRI enabled a 3-dimensional reconstruction of S1, S2, and S3. Fractional anisotropy was calculated for each root. Laparoscopic treatment of endometriosis was performed in 56 patients. MEASUREMENTS AND MAIN RESULTS Our findings revealed correlations among sacral root reconstruction by MRI-DTI, pain symptoms, and laparoscopic findings. DTI of sacral roots revealed a regular and homogeneous appearance in 17 patients (25.8%) and abnormalities in microstructure reconstruction, with fiber irregularities and disorganization and loss of the simple unidirectional course, in 44 patients (66.7%). At laparoscopy, ovarian endometriomas were found in 82.1% of the patients, and deeply infiltrating endometriosis (DIE) were found in 57.1%. Endometriosis was staged according to the revised American Society for Reproductive Medicine classification. Pathological DTI findings were significantly associated with the severity of dysmenorrhea and NCPP, pain duration, presence of tubo-ovarian and cul-de-sac adhesions, and DIE. CONCLUSION The presence of pathological DTI findings of the sacral nerve roots correlates with the type of pain, adhesions, and DIE. At present, DTI can be useful for providing a better understanding of pain; however, DTI could become a useful tool in therapeutic planning for patients with endometriosis.
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Affiliation(s)
- Maria Grazia Porpora
- Department of Gynecological and Obstetrical Sciences and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy.
| | - Valeria Vinci
- Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Corrado De Vito
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Giuseppe Migliara
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Emanuela Anastasi
- Department of Molecular Medicine, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Adele Ticino
- Department of Gynecological and Obstetrical Sciences and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Serena Resta
- Department of Gynecological and Obstetrical Sciences and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Pierluigi Benedetti Panici
- Department of Gynecological and Obstetrical Sciences and Urological Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Lucia Manganaro
- Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy
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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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Wadhwa V, Hamid AS, Kumar Y, Scott KM, Chhabra A. Pudendal nerve and branch neuropathy: magnetic resonance neurography evaluation. Acta Radiol 2017; 58:726-733. [PMID: 27664277 DOI: 10.1177/0284185116668213] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Pudendal neuralgia is being increasingly recognized as a cause of chronic pelvic pain, which may be related to nerve injury or entrapment. Due to its complex anatomy and branching patterns, the pudendal nerve abnormalities are challenging to illustrate. High resolution 3 T magnetic resonance neurography is a promising technique for the evaluation of peripheral neuropathies. In this article, the authors discuss the normal pudendal nerve anatomy and its variations, technical considerations of pudendal nerve imaging, and highlight the normal and abnormal appearances of the pudendal nerve and its branches with illustrative case examples.
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Affiliation(s)
- Vibhor Wadhwa
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Aws S Hamid
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Yogesh Kumar
- Department of Radiology, Yale New Haven Health System at Bridgeport Hospital, Bridgeport, Connecticut, USA
| | - Kelly M Scott
- Department of Physical Medicine & Rehabilitation, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Avneesh Chhabra
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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25
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Rogers PAW, Adamson GD, Al-Jefout M, Becker CM, D’Hooghe TM, Dunselman GAJ, Fazleabas A, Giudice LC, Horne AW, Hull ML, Hummelshoj L, Missmer SA, Montgomery GW, Stratton P, Taylor RN, Rombauts L, Saunders PT, Vincent K, Zondervan KT. Research Priorities for Endometriosis. Reprod Sci 2017; 24:202-226. [PMID: 27368878 PMCID: PMC5933154 DOI: 10.1177/1933719116654991] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The 3rd International Consensus Workshop on Research Priorities in Endometriosis was held in São Paulo on May 4, 2014, following the 12th World Congress on Endometriosis. The workshop was attended by 60 participants from 19 countries and was divided into 5 main sessions covering pathogenesis/pathophysiology, symptoms, diagnosis/classification/prognosis, disease/symptom management, and research policy. This research priorities consensus statement builds on earlier efforts to develop research directions for endometriosis. Of the 56 research recommendations from the 2011 meeting in Montpellier, a total of 41 remained unchanged, 13 were updated, and 2 were deemed to be completed. Fifty-three new research recommendations were made at the 2014 meeting in Sao Paulo, which in addition to the 13 updated recommendations resulted in a total of 66 new recommendations for research. The research recommendations published herein, as well as those from the 2 previous papers from international consensus workshops, are an attempt to promote high-quality research in endometriosis by identifying and agreeing on key issues that require investigation. New areas included in the 2014 recommendations include infertility, patient stratification, and research in emerging nations, in addition to an increased focus on translational research. A revised and updated set of research priorities that builds on this document will be developed at the 13th World Congress on Endometriosis to be held on May 17-20, 2017, in Vancouver, British Columbia, Canada.
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Affiliation(s)
| | - G. David Adamson
- Palo Alto Medical Foundation Fertility Physicians of Northern California,
Palo Alto, CA, USA
- World Endometriosis Research Foundation (WERF), London, United Kingdom
| | | | - Christian M. Becker
- Nuffield Department of Obstetrics & Gynaecology, Endometriosis Care
Centre, Oxford, United Kingdom
| | | | - Gerard A. J. Dunselman
- Department of Obstetrics & Gynaecology, Research Institute GROW,
Maastricht University Medical Centre, Maastricht, the Netherlands
| | | | - Linda C. Giudice
- World Endometriosis Research Foundation (WERF), London, United Kingdom
- University of California, San Francisco, CA, USA
- World Endometriosis Society (WES), Vancouver, Canada
| | - Andrew W. Horne
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh,
United Kingdom
| | - M. Louise Hull
- The Robinson Institute, University of Adelaide, Adelaide, Australia
| | - Lone Hummelshoj
- World Endometriosis Research Foundation (WERF), London, United Kingdom
- World Endometriosis Society (WES), Vancouver, Canada
| | - Stacey A. Missmer
- World Endometriosis Research Foundation (WERF), London, United Kingdom
- Harvard Schools of Medicine and Public Health, Boston, MA, USA
| | | | | | - Robert N. Taylor
- World Endometriosis Society (WES), Vancouver, Canada
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Luk Rombauts
- World Endometriosis Research Foundation (WERF), London, United Kingdom
- World Endometriosis Society (WES), Vancouver, Canada
- Monash University, Clayton, Australia
| | - Philippa T. Saunders
- MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh,
United Kingdom
| | - Katy Vincent
- Nuffield Department of Obstetrics & Gynaecology, Endometriosis Care
Centre, Oxford, United Kingdom
| | - Krina T. Zondervan
- Nuffield Department of Obstetrics & Gynaecology, Endometriosis Care
Centre, Oxford, United Kingdom
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford,
United Kingdom
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26
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Bazot M, Bharwani N, Huchon C, Kinkel K, Cunha TM, Guerra A, Manganaro L, Buñesch L, Kido A, Togashi K, Thomassin-Naggara I, Rockall AG. European society of urogenital radiology (ESUR) guidelines: MR imaging of pelvic endometriosis. Eur Radiol 2016; 27:2765-2775. [PMID: 27921160 PMCID: PMC5486785 DOI: 10.1007/s00330-016-4673-z] [Citation(s) in RCA: 161] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 10/05/2016] [Accepted: 11/23/2016] [Indexed: 12/21/2022]
Abstract
Abstract Endometriosis is a common gynaecological condition of unknown aetiology that primarily affects women of reproductive age. The accepted first-line imaging modality is pelvic ultrasound. However, magnetic resonance imaging (MRI) is increasingly performed as an additional investigation in complex cases and for surgical planning. There is currently no international consensus regarding patient preparation, MRI protocols or reporting criteria. Our aim was to develop clinical guidelines for MRI evaluation of pelvic endometriosis based on literature evidence and consensus expert opinion. This work was performed by a group of radiologists from the European Society of Urogenital Radiology (ESUR), experts in gynaecological imaging and a gynaecologist expert in methodology. The group discussed indications for MRI, technical requirements, patient preparation, MRI protocols and criteria for the diagnosis of pelvic endometriosis on MRI. The expert panel proposed a final recommendation for each criterion using Oxford Centre for Evidence Based Medicine (OCEBM) 2011 levels of evidence. Key Points • This report provides guidelines for MRI in endometriosis. • Minimal and optimal MRI acquisition protocols are provided. • Recommendations are proposed for patient preparation, best MRI sequences and reporting criteria. Electronic supplementary material The online version of this article (doi:10.1007/s00330-016-4673-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M Bazot
- Department of Radiology, Tenon Hospital, 58 Avenue Gambetta, Paris, 75020, France.
| | - N Bharwani
- Department of Radiology, St Mary's Hospital, Imperial College Healthcare NHS Trust, 3rd Floor Queen Elizabeth the Queen Mother Building, Praed Street, London, W2 1NY, UK
| | - C Huchon
- Department of Obtetrics and Gynaecology, CHI Poissy Saint-Germain en Laye,Versailles University France, 10 rue du champ Gaillard, 78300, Poissy, France
| | - K Kinkel
- Institut de radiologie, Clinique des Grangettes, 7, chemin des Grangettes, CH 1224, Chêne-Bougeries, Switzerland
| | - T M Cunha
- Serviço de Radiologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Prof. Lima Basto, 1099-023, Lisboa, Portugal
| | - A Guerra
- Department of Radiology, Hospital da Luz, Lisbon, Portugal
| | - L Manganaro
- Department of Radiological Sciences, Sapienza University of Rome, Vle. Regina Elena 324, 00162, Rome, Italy
| | - L Buñesch
- Department of Radiology (Urogenital Section), Hospital Clínic Barcelona, Villarroel, 170, Barcelona, 08036, Spain
| | - A Kido
- Department of Diagnostic Radiology, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - K Togashi
- Department of Diagnostic Radiology, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - I Thomassin-Naggara
- Department of Radiology, Tenon Hospital, 58 Avenue Gambetta, Paris, 75020, France
| | - A G Rockall
- Department of Radiology, The Royal Marsden Hospital, Fulham Road, London, SW3 6JJ, UK
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Weissman E, Boothe E, Wadhwa V, Scott K, Chhabra A. Magnetic Resonance Neurography of the Pelvic Nerves. Semin Ultrasound CT MR 2016; 38:269-278. [PMID: 28705371 DOI: 10.1053/j.sult.2016.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Chronic pelvic pain syndrome is commonly caused by nerve injury, inflammation, or entrapment. Owing to the complex anatomy and branching patterns of pelvic nerves, pelvic neuropathies are often difficult to illustrate and diagnose. High-resolution 3-T magnetic resonance neurography is a promising technique for the evaluation of peripheral neuropathy. In this article, the authors discuss the normal anatomy of major pelvic nerves, technical considerations of high-resolution imaging, and normal and abnormal imaging appearances with relevant case examples.
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Affiliation(s)
- Eric Weissman
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Ethan Boothe
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Vibhor Wadhwa
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Kelly Scott
- Department of Physical Medicine & Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX
| | - Avneesh Chhabra
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX; Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
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28
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Zhang X, Li M, Guan J, Wang H, Li S, Guo Y, Liu M. Evaluation of the sacral nerve plexus in pelvic endometriosis by three-dimensional MR neurography. J Magn Reson Imaging 2016; 45:1225-1231. [PMID: 27666420 DOI: 10.1002/jmri.25435] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 08/08/2016] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To investigate the feasibility of three-dimensional MR neurography (3D MRN) for the sacral plexus using sampling perfection with application-optimized contrasts using different flip angle evolution (SPACE) sequences, and to demonstrate structural abnormalities in the pelvic nerve of women with pelvic endometriosis. MATERIALS AND METHODS Twenty patients with pelvic endometriosis and 20 healthy controls were examined by contrast-enhanced 3D short time inversion recovery T2-weighted imaging (CE 3D STIR T2WI) SPACE sequences on 3 Tesla MRI. Image quality and diagnostic confidence of the sequences in identifying abnormalities of the sacral plexus were analyzed and compared with conventional three-plane images of 2D turbo-spin echo T2-weighted images (2D TSE T2WI). The changes in the sacral plexus caused by endometrial lesions were evaluated. RESULTS The sacral plexus was clearly revealed in both healthy controls and patients with endometriosis on 3D STIR SPACE images. A good agreement was reached in the evaluation of both imaging quality (Kappa value [κ] = 0.73-1.00) and diagnostic confidence (κ = 0.66-0.81) when compared between the two independent readers. Abnormalities caused by endometriosis were identified in 17 patients, unilaterally in 10 patients, and bilaterally in 7 patients. Nerve fiber abnormalities of lumbar 5 (L5) were detected in 11 patients, of sacral 1 (S1) in 14 patients and of sacral 2 (S2) in 9 patients. CONCLUSION CE 3D STIR SPACE sequences demonstrate its significant capacity to investigate and map the sacral plexus, and reveal the compression and adhesion of the sacral plexus nerve as a result of ectopic lesions. LEVEL OF EVIDENCE 3 J. Magn. Reson. Imaging 2017;45:1225-1231.
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Affiliation(s)
- Xiaoling Zhang
- Department of Radiology, First affiliated hospital of Sun Yat-sen University, Guangzhou, China
| | - Meizhi Li
- Department of Radiology, First affiliated hospital of Sun Yat-sen University, Guangzhou, China
| | - Jian Guan
- Department of Radiology, First affiliated hospital of Sun Yat-sen University, Guangzhou, China
| | - Huanjun Wang
- Department of Radiology, First affiliated hospital of Sun Yat-sen University, Guangzhou, China
| | - Shurong Li
- Department of Radiology, First affiliated hospital of Sun Yat-sen University, Guangzhou, China
| | - Yan Guo
- Department of Radiology, First affiliated hospital of Sun Yat-sen University, Guangzhou, China
| | - Mingjuan Liu
- Department of Radiology, First affiliated hospital of Sun Yat-sen University, Guangzhou, China
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Wu W, Liang J, Ru N, Zhou C, Chen J, Wu Y, Yang Z. Microstructural Changes in Compressed Nerve Roots Are Consistent With Clinical Symptoms and Symptom Duration in Patients With Lumbar Disc Herniation. Spine (Phila Pa 1976) 2016; 41:E661-E666. [PMID: 26656057 DOI: 10.1097/brs.0000000000001354] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective study. OBJECTIVE To investigate the association between microstructural nerve roots changes on diffusion tensor imaging (DTI) and clinical symptoms and their duration in patients with lumbar disc herniation. SUMMARY OF BACKGROUND DATA The ability to identify microstructural properties of the nervous system with DTI has been demonstrated in many studies. However, there are no data regarding the association between microstructural changes evaluated using DTI and symptoms assessed with the Oswestry Disability Index (ODI) and their duration. METHODS Forty consecutive patients with foraminal disc herniation affecting unilateral sacral 1 (S1) nerve roots were enrolled in this study. DTI with tractography was performed on the S1 nerve roots. Clinical symptoms were evaluated using an ODI questionnaire for each patient, and the duration of clinical symptoms was noted based on the earliest instance of leg pain and numbness. Mean fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values were calculated from tractography images. RESULTS The mean FA value of the compressed lumbar nerve roots was significantly lower than the FA of the contralateral nerve roots (P < 0.001). No notable difference in ADC was observed between compressed nerve roots and contralateral nerve roots (P = 0.517). In the compressed nerve roots, a significant negative association was observed between FA values and ODI and symptom duration. However, an obvious positive association was observed between ODI and ADC values and duration on the compressed side. CONCLUSION Significant changes in diffusion parameters were found in the compressed sacral nerves in patients with lumbar disc herniation and leg pain, indicating that the microstructure of the nerve root has been damaged. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Weifei Wu
- Department of Orthopedics, the People's Hospital of Three Gorges University, the First People's Hospital of Yichang, Hubei, China
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Cimsit C, Yoldemir T, Akpinar IN. Sciatic neuroendometriosis: Magnetic resonance imaging defined perineural spread of endometriosis. J Obstet Gynaecol Res 2016; 42:890-894. [DOI: 10.1111/jog.12998] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Revised: 01/27/2016] [Accepted: 02/18/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Canan Cimsit
- Department of Radiology; Marmara University Training and Research Hospital; Istanbul Turkey
| | - Tevfik Yoldemir
- Department of Radiology; Marmara University Training and Research Hospital; Istanbul Turkey
| | - Ihsan Nuri Akpinar
- Department of Radiology; Marmara University Training and Research Hospital; Istanbul Turkey
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31
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MRI technique for the preoperative evaluation of deep infiltrating endometriosis: current status and protocol recommendation. Clin Radiol 2016; 71:179-94. [DOI: 10.1016/j.crad.2015.09.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 08/20/2015] [Accepted: 09/16/2015] [Indexed: 12/31/2022]
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Rangavajla G, Mokarram N, Masoodzadehgan N, Pai SB, Bellamkonda RV. Noninvasive imaging of peripheral nerves. Cells Tissues Organs 2015; 200:69-77. [PMID: 25766202 DOI: 10.1159/000369451] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2014] [Indexed: 12/19/2022] Open
Abstract
Recent developments in the field of peripheral nerve imaging extend the capabilities of imaging modalities to assist in the diagnosis and treatment of patients with peripheral nerve maladies. Methods such as magnetic resonance imaging (MRI) and its derivative diffusion tensor imaging (DTI), ultrasound (US) and positron emission tomography (PET) are capable of assessing nerve structure and function following injury and relating the state of the nerve to electrophysiological and histological analysis. Of the imaging methods surveyed here, each offered unique and interesting advantages related to the field. MRI offered the opportunity to visualize immune activity on the injured nerve throughout the course of the regeneration process, and DTI offered numerical characterization of the injury and the ability to develop statistical bases for diagnosing injury. US extends imaging to the treatment phase by enabling more precise analgesic applications following surgery, and PET represents a novel method of assessing nerve injury through analysis of relative metabolism rates in injured and healthy tissue. Exciting new possibilities to enhance and extend the abilities of imaging methods are also discussed, including innovative contrast agents, some of which enable multimodal imaging approaches and present opportunities for treatment application.
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Increased dose single-agent gemcitabine in platinum-taxane resistant metastatic ovarian cancer. TUMORI JOURNAL 2015; 101:36-40. [PMID: 25702671 DOI: 10.5301/je.5000209] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2014] [Indexed: 11/20/2022]
Abstract
CONCLUSION In platinum–taxane resistant epithelial ovarian cancer (EOC), we aimed to determine the effectiveness. PATIENTS AND METHODS Between 2004 and 2013, patients afflicted with platinum–taxane resistant EOC and who were administered a 30-minute i.v. infusion of single-agent gemcitabine at a dose of 1,250 mg/m2 on the 1st, 8th and 15th days, every 28 days, were examined retrospectively. RESULTS Twenty-six patients with platinum–taxane resistant EOC were included in the study. The overall survival (OS) was 48 months. The median survival after becoming platinum–taxane resistant was 16 months for the study population. Median time to progression (TTP) and median survival after becoming platinum–taxane resistant for patients who received second-line treatment were 3.3 months and 16 months, respectively; for patients who received third-line treatment with gemcitabine, these were 3.7 months and 19 months, respectively. Administration of gemcitabine as second- and third-line chemotherapy in platinum–taxane resistant EOC, provides similar TTP and OS outcomes (p = 0.4, p = 0.9) with a similar response and toxicity rate. CONCLUSIONS Second- and third-line gemcitabine at a dose of 1,250 mg/m2 on days 1, 8 and 15 every 28 days as a 30-minute i.v. infusion in platinum–taxane resistant EOC is an effective treatment option with a tolerable and manageable toxicity.
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34
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Conventional ultrasound integrated with elastosonography and B-flow imaging in the diagnosis of thyroid nodular lesions. Int J Surg 2014; 12 Suppl 1:S117-22. [DOI: 10.1016/j.ijsu.2014.05.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 05/03/2014] [Indexed: 11/19/2022]
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35
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Imaging for the evaluation of endometriosis and adenomyosis. Best Pract Res Clin Obstet Gynaecol 2014; 28:655-81. [DOI: 10.1016/j.bpobgyn.2014.04.010] [Citation(s) in RCA: 165] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 04/10/2014] [Accepted: 04/23/2014] [Indexed: 01/21/2023]
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Linnman C, Borsook D. Completing the Pain Circuit: Recent Advances in Imaging Pain and Inflammation beyond the Central Nervous System. Rambam Maimonides Med J 2013; 4:e0026. [PMID: 24228169 PMCID: PMC3820299 DOI: 10.5041/rmmj.10133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
This review describes some of the recent developments in imaging aspects of pain in the periphery. It is now possible to image nerves in the cornea non-invasively, to image receptor level expression and inflammatory processes in injured tissue, to image nerves and alterations in nerve properties, to image astrocyte and glial roles in neuroinflammatory processes, and to image pain conduction functionally in the trigeminal ganglion. These advances will ultimately allow us to describe the pain pathway, from injury site to behavioral consequence, in a quantitative manner. Such a development could lead to diagnostics determining the source of pain (peripheral or central), objective monitoring of treatment progression, and, hopefully, objective biomarkers of pain.
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Affiliation(s)
- Clas Linnman
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, United States of America
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