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Rousset P, Florin M, Bharwani N, Touboul C, Monroc M, Golfier F, Nougaret S, Thomassin-Naggara I. Deep pelvic infiltrating endometriosis: MRI consensus lexicon and compartment-based approach from the ENDOVALIRM group. Diagn Interv Imaging 2023; 104:95-112. [PMID: 36404224 DOI: 10.1016/j.diii.2022.09.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this consensus article was to develop guidelines by a focused panel of experts to elaborate a lexicon of image interpretation, and a standardized region-based reporting of deep infiltrating endometriosis (DIE) with magnetic resonance imaging (MRI). MATERIALS AND METHODS Evidence-based data and expert opinion were combined using the RAND-UCLA Appropriateness Method to attain consensus guidelines. Experts scoring of pelvic compartment delineation and reporting template were collected; responses were analyzed and classified as "RECOMMENDED" versus "NOT RECOMMENDED" (when ≥ 80% consensus among experts) or uncertain (when < 80% consensus among experts). RESULTS Consensus regarding pelvic compartment delineation and DIE reporting was attained using the RAND-UCLA Appropriateness Method. The pelvis was divided in nine compartments and extrapelvic lesions were assigned to an additional (tenth) compartment. A consensus was also reached for each structure attributed to a compartment and each reporting template item among the experts. No consensus was reached for a normal aspect of uterosacral ligament, but a consensus was reached for an unequivocal involvement leading to a positive diagnosis and an equivocal involvement leading to uncertain diagnosis. Tailored MRI lexicon and standardized region-based report were proposed. CONCLUSION These consensus recommendations should be used as a guide for DIE reporting and staging with MRI. Standardized MRI compartment-based structured reporting is recommended to enable consistent accuracy and help select the best therapeutic approach.
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Affiliation(s)
- Pascal Rousset
- Department of Diagnostic and Interventional Imaging, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon 1 Claude Bernard University, CICLY - EA3738, Pierre Bénite 69495, France.
| | - Marie Florin
- Department of Diagnostic and Interventional Imaging, Assistance Publique Hôpitaux de Paris, Hôpital Tenon, Paris 75020, France
| | - Nishat Bharwani
- Service for Urological and Gynecological Imaging, Imperial College Healthcare NHS Trust, London, England
| | - Cyril Touboul
- Department of Gynecology and Obstetrics, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, INSERM UMRS 938, Paris 75020, France
| | - Michèle Monroc
- Department of Radiology, Clinique Saint Antoine, Bois Guillaume 76230, France
| | - François Golfier
- Department of Gynecological and Oncological Surgery, Obstetrics, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon 1 Claude Bernard University, CICLY - EA3738, Pierre Bénite 69495, France
| | - Stéphanie Nougaret
- Department of Radiology, Montpellier Cancer Institute, U1194, Montpellier University, Montpellier 34295, France
| | - Isabelle Thomassin-Naggara
- Department of Diagnostic and Interventional Imaging, Assistance Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, Paris 75020, France
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Doroftei B, Armeanu T, Maftei R, Ilie OD, Dabuleanu AM, Condac C. Abdominal Wall Endometriosis: Two Case Reports and Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:727. [PMID: 33371515 PMCID: PMC7767517 DOI: 10.3390/medicina56120727] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/17/2020] [Accepted: 12/17/2020] [Indexed: 12/20/2022]
Abstract
Background and objectives: Abdominal wall endometriosis, also known as scar endometriosis, is a rare condition that is becoming increasingly common. The recent rise in incidence is attributed primarily to the surge of cesarean births, figures that could be influenced in a positive manner considering the improvements brought towards the ultrasound diagnostic methods that have been made in recent years. Materials and Methods: Here we report the cases of two Caucasian women of 38- (G2P2) and 36-years old (G1P1), both subjected to an ultrasound examination due to a specific symptomatic panel reported during anamnesis. Independently of the current status, in the first patient, there were no reported symptom-specific associations with endometriosis, but she had a known history of mild hereditary thrombophilia; the second woman suffered from two conditions positively associated with endometriosis. Results: In both cases, abnormal structures were revealed, with the diagnostic(s) of endometriosis being histologically confirmed based on a set of features observed during the investigation. Conclusions: This paper aims to highlight the importance of reducing cesarean births and to consider the diagnosis of scar endometriosis in women with a history of obstetric or gynaecological surgeries who present with cyclic, recurrent abdominal pain.
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Affiliation(s)
- Bogdan Doroftei
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, no 16, 700115 Iasi, Romania; (B.D.); (R.M.); (A.-M.D.)
- Clinical Hospital of Obstetrics and Gynecology “Cuza Voda”, Cuza Voda Street, no 34, 700038 Iasi, Romania
- Origyn Fertility Center, Palace Street, no 3C, 700032 Iasi, Romania
| | - Theodora Armeanu
- Clinical Hospital of Obstetrics and Gynecology “Cuza Voda”, Cuza Voda Street, no 34, 700038 Iasi, Romania
- Origyn Fertility Center, Palace Street, no 3C, 700032 Iasi, Romania
| | - Radu Maftei
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, no 16, 700115 Iasi, Romania; (B.D.); (R.M.); (A.-M.D.)
- Clinical Hospital of Obstetrics and Gynecology “Cuza Voda”, Cuza Voda Street, no 34, 700038 Iasi, Romania
- Origyn Fertility Center, Palace Street, no 3C, 700032 Iasi, Romania
| | - Ovidiu-Dumitru Ilie
- Department of Biology, Faculty of Biology, “Alexandru Ioan Cuza” University, Carol I Avenue, no 20A, 700505 Iasi, Romania
| | - Ana-Maria Dabuleanu
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, no 16, 700115 Iasi, Romania; (B.D.); (R.M.); (A.-M.D.)
- Clinical Hospital of Obstetrics and Gynecology “Cuza Voda”, Cuza Voda Street, no 34, 700038 Iasi, Romania
- Origyn Fertility Center, Palace Street, no 3C, 700032 Iasi, Romania
| | - Constantin Condac
- Faculty of Medicine, “Lucian Blaga” University, Victoriei Avenue, no 10, 550024 Sibiu, Romania;
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Vaiarelli A, Venturella R, Cimadomo D, Conforti A, Pedri S, Bitonti G, Iussig B, Gentile C, Alviggi E, Santopaolo S, Zullo F, Rienzi L, Ubaldi FM. Endometriosis shows no impact on the euploid blastocyst rate per cohort of inseminated metaphase-II oocytes: A case-control study. Eur J Obstet Gynecol Reprod Biol 2020; 256:205-210. [PMID: 33246206 DOI: 10.1016/j.ejogrb.2020.11.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/02/2020] [Accepted: 11/06/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To evaluate the true impact of endometriosis on oocytes' competence defined as blastulation, euploidy and implantation rates. DESIGN Retrospective multicenter case-control study involving infertile couples undergoing ICSI with qPCR and trophectoderm biopsy-based PGT-A. Patients affected from endometriosis (n = 210) were diagnosed through transvaginal sonography or surgical history with histological confirmation. Each case was matched to two controls (n = 420) according to IVF clinic, maternal age at retrieval (38.6 ± 2.7 yr), number of previous failed IVF treatments (0.5 ± 0.8) and number of metaphase-II oocytes retrieved (6.1 ± 3.7 per patient). The primary outcome was the mean euploid blastocyst rate per cohort of inseminated metaphase-II oocytes. Other embryological, clinical, obstetric and neonatal outcomes were also evaluated. RESULTS The mean euploid blastocyst rate per cohort of inseminated metaphase-II oocytes was identical in the two groups (18 %±22 %) independently of maternal age. No difference was shown for all embryological outcomes investigated. The live birth rates per vitrified-warmed single euploid blastocyst transfer were also similar (67/158, 42 % in patients affected from endometriosis versus 132/327, 40 % in matched-controls). No difference was reported in the gestational and neonatal outcomes. The cumulative live birth delivery rates among completed cycles were also identical (61/201, 30 % versus 117/391, 30 % in endometriosis and matched-control groups, respectively) independently of maternal age. CONCLUSIONS Endometriosis might not impair oocyte developmental and reproductive competence, although its potential impact on the number of metaphase-II oocytes retrieved cannot be ignored. This information is critical for clinicians during counseling to outline an effective strategy to treat infertile patients affected from this condition. Future prospective studies are needed to evaluate the impact of endometriosis stage on euploidy rates.
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Affiliation(s)
- Alberto Vaiarelli
- Clinica Valle Giulia, GENERA Centers for Reproductive Medicine, Rome, Italy
| | - Roberta Venturella
- Magna Graecia University, Department of Experimental and Clinical Medicine, ART Center, Catanzaro, Italy.
| | - Danilo Cimadomo
- Clinica Valle Giulia, GENERA Centers for Reproductive Medicine, Rome, Italy; GENERA Veneto, GENERA Centers for Reproductive Medicine, Marostica, Italy; Clinica Ruesch, GENERA Centers for Reproductive Medicine, Naples, Italy
| | - Alessandro Conforti
- University "Federico II" of Naples, Department of Neuroscience, Reproductive Science and Odontostomatology, Italy
| | - Sara Pedri
- Magna Graecia University, Department of Experimental and Clinical Medicine, ART Center, Catanzaro, Italy
| | - Giovanna Bitonti
- Magna Graecia University, Department of Experimental and Clinical Medicine, ART Center, Catanzaro, Italy
| | - Benedetta Iussig
- GENERA Veneto, GENERA Centers for Reproductive Medicine, Marostica, Italy
| | - Cinzia Gentile
- GENERA Veneto, GENERA Centers for Reproductive Medicine, Marostica, Italy
| | - Erminia Alviggi
- Clinica Ruesch, GENERA Centers for Reproductive Medicine, Naples, Italy
| | - Serena Santopaolo
- Clinica Ruesch, GENERA Centers for Reproductive Medicine, Naples, Italy
| | - Fulvio Zullo
- Magna Graecia University, Department of Experimental and Clinical Medicine, ART Center, Catanzaro, Italy; University "Federico II" of Naples, Department of Neuroscience, Reproductive Science and Odontostomatology, Italy
| | - Laura Rienzi
- Clinica Valle Giulia, GENERA Centers for Reproductive Medicine, Rome, Italy; GENERA Veneto, GENERA Centers for Reproductive Medicine, Marostica, Italy; Clinica Ruesch, GENERA Centers for Reproductive Medicine, Naples, Italy
| | - Filippo Maria Ubaldi
- Clinica Valle Giulia, GENERA Centers for Reproductive Medicine, Rome, Italy; GENERA Veneto, GENERA Centers for Reproductive Medicine, Marostica, Italy; Clinica Ruesch, GENERA Centers for Reproductive Medicine, Naples, Italy
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4
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Zhou Y, Su Y, Liu H, Wu H, Xu J, Dong F. Accuracy of transvaginal ultrasound for diagnosis of deep infiltrating endometriosis in the uterosacral ligaments: Systematic review and meta-analysis. J Gynecol Obstet Hum Reprod 2020; 50:101953. [PMID: 33148442 DOI: 10.1016/j.jogoh.2020.101953] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To review the diagnostic accuracy of transvaginal ultrasound (TVS) in the preoperative detection of uterosacral ligaments (USL) in patients with clinical suspicion of deep infiltrating endometriosis (DIE). METHODS Extensive searches were conducted in PubMed, EMBASE and Cochrane libraries to search studies published between January 1989 and September 2, 2019. The inclusion criteria were the preoperative assessment of USL endometriosis by TVS in patients with clinically suspected DIE, using laparoscopy and histological results as the reference standard. The assessment of research quality uses preferred reporting items, including the System Review and Meta Analysis (PRISMA) guidelines, as well as the quality assessment of diagnostic accuracy study 2 (QUADAS-2) tools. RESULTS During our advanced search, 7562 studies were identified. Finally, 11 of which were recognized as qualified and incorporated into this study. The pooled sensitivity, specificity, positive probability ratio (LR+) and negative probability ratio(LR-) of TVS for detecting DIE in the USL were 65 %(95 %CI:43-83), 92 %(95 %CI:84-96), 7.80 (95 %CI:4.7-13.0) and 0.38(95 %CI:0.22-0.66), respectively. There was significant heterogeneity in sensitivity (I2: 97.40 %; Cochran Q, 385.09; P<0.001) and specificity (I2, 93.89 %; Cochran Q, 163.75; P < 0.001). CONCLUSION TVS provides an excellent comprehensive diagnostic performance for DIE of the USL. However, further research is required to improve the diagnostic quality.
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Affiliation(s)
- Yuli Zhou
- Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, 518020, PR China
| | - Youhuan Su
- Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, 518020, PR China
| | - Huiyu Liu
- Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, 518020, PR China
| | - Huaiyu Wu
- Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, 518020, PR China
| | - Jinfeng Xu
- Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, 518020, PR China.
| | - Fajin Dong
- Department of Ultrasound, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical College of Jinan University, Shenzhen People's Hospital, Shenzhen, 518020, PR China.
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5
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Bielen D, Tomassetti C, Van Schoubroeck D, Vanbeckevoort D, De Wever L, Van den Bosch T, D'Hooghe T, Bourne T, D'Hoore A, Wolthuis A, Van Cleynenbreughel B, Meuleman C, Timmerman D. IDEAL study: magnetic resonance imaging for suspected deep endometriosis assessment prior to laparoscopy is as reliable as radiological imaging as a complement to transvaginal ultrasonography. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 56:255-266. [PMID: 31503381 DOI: 10.1002/uog.21868] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 07/18/2019] [Accepted: 08/27/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To compare the value of using one-stop magnetic resonance imaging (MRI) vs standard radiological imaging as a supplement to transvaginal ultrasonography (TVS) for the preoperative assessment of patients with endometriosis referred for surgery in a tertiary care academic center. METHODS This prospective observational study compared the diagnostic value of the standard preoperative imaging practice of our center, which involves expert TVS complemented by intravenous urography (IVU) for the evaluation of the ureters and double-contrast barium enema (DCBE) for the evaluation of the rectum, sigmoid and cecum, with that of expert TVS complemented by a 'one-stop' MRI examination evaluating the upper abdomen, pelvis, kidneys and ureters as well as rectum and sigmoid on the same day, for the preoperative triaging of 74 women with clinically suspected deep endometriosis. The findings at laparoscopy were considered the reference standard. Patients were stratified according to their need for monodisciplinary surgical approach, carried out by gynecologists only, or multidisciplinary surgical approach, involving abdominal surgeons and/or urologists, based on the extent to which endometriosis affected the reproductive organs, bowel, ureters, bladder or other abdominal organs. RESULTS Our standard preoperative imaging approach and the combined findings of TVS and MRI had similar diagnostic performance, resulting in correct stratification for a monodisciplinary or a multidisciplinary surgical approach of 67/74 (90.5%) patients. However, there were differences between the estimation of the severity of disease by DCBE and MRI. The severity of rectal involvement was underestimated in 2.7% of the patients by both TVS and DCBE, whereas it was overestimated in 6.8% of the patients by TVS and/or DCBE. CONCLUSIONS Complementary to expert TVS, 'one-stop' MRI can predict intraoperative findings equally well as standard radiological imaging (IVU and DCBE) in patients referred for endometriosis surgery in a tertiary care academic center. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- D Bielen
- Department of Radiology, KU Leuven University Hospitals, Leuven, Belgium
- Department of Imaging and Pathology, KU Leuven University Hospitals, Leuven, Belgium
| | - C Tomassetti
- Leuven University Fertility Center, KU Leuven University Hospitals, Leuven, Belgium
- Department of Obstetrics and Gynecology, KU Leuven University Hospitals, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven University Hospitals, Leuven, Belgium
| | - D Van Schoubroeck
- Department of Obstetrics and Gynecology, KU Leuven University Hospitals, Leuven, Belgium
| | - D Vanbeckevoort
- Department of Radiology, KU Leuven University Hospitals, Leuven, Belgium
| | - L De Wever
- Department of Radiology, KU Leuven University Hospitals, Leuven, Belgium
| | - T Van den Bosch
- Department of Obstetrics and Gynecology, KU Leuven University Hospitals, Leuven, Belgium
| | - T D'Hooghe
- Leuven University Fertility Center, KU Leuven University Hospitals, Leuven, Belgium
- Global Medical Affairs Fertility, Merck Healthcare KGaA, Darmstadt, Germany
| | - T Bourne
- Department of Obstetrics and Gynecology, KU Leuven University Hospitals, Leuven, Belgium
- Department of Gynecology and Obstetrics, Imperial College Healthcare NHS Trust, London, UK
| | - A D'Hoore
- Department of Abdominal Surgery, KU Leuven University Hospitals, Leuven, Belgium
- Department of Oncology, KU Leuven University Hospitals, Leuven, Belgium
| | - A Wolthuis
- Department of Abdominal Surgery, KU Leuven University Hospitals, Leuven, Belgium
- Department of Oncology, KU Leuven University Hospitals, Leuven, Belgium
| | | | - C Meuleman
- Department of Obstetrics and Gynecology, KU Leuven University Hospitals, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven University Hospitals, Leuven, Belgium
- Leuven University Endometriosis Center, KU Leuven University Hospitals, Leuven, Belgium
| | - D Timmerman
- Department of Obstetrics and Gynecology, KU Leuven University Hospitals, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven University Hospitals, Leuven, Belgium
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6
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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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Tong A, VanBuren WM, Chamié L, Feldman M, Hindman N, Huang C, Jha P, Kilcoyne A, Laifer-Narin S, Nicola R, Poder L, Sakala M, Shenoy-Bhangle AS, Taffel MT. Recommendations for MRI technique in the evaluation of pelvic endometriosis: consensus statement from the Society of Abdominal Radiology endometriosis disease-focused panel. Abdom Radiol (NY) 2020; 45:1569-1586. [PMID: 32193592 DOI: 10.1007/s00261-020-02483-w] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Endometriosis is a common entity causing chronic pain and infertility in women. The gold standard method for diagnosis is diagnostic laparoscopy, which is invasive and costly. MRI has shown promise in its ability to diagnose endometriosis and its efficacy for preoperative planning. The Society of Abdominal Radiology established a Disease-Focused Panel (DFP) to improve patient care for patients with endometriosis. In this article, the DFP performs a literature review and uses its own experience to provide technical recommendations on optimizing MRI Pelvis for the evaluation of endometriosis.
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Affiliation(s)
- Angela Tong
- Department of Radiology, New York University Langone Health, 660 1st Ave, 3rd Floor, New York, NY, 10016, USA.
| | | | - Luciana Chamié
- Department of Diagnostic Imaging, Chamié Imagem da Mulher, Fleury Medicina e Saúde, São Paulo, Brazil
| | - Myra Feldman
- Cleveland Clinic Imaging Institute, Cleveland, OH, USA
| | - Nicole Hindman
- Department of Radiology, New York University Langone Health, 660 1st Ave, 3rd Floor, New York, NY, 10016, USA
| | - Chenchan Huang
- Department of Radiology, New York University Langone Health, 660 1st Ave, 3rd Floor, New York, NY, 10016, USA
| | - Priyanka Jha
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Aoife Kilcoyne
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Refky Nicola
- Roswell Park Cancer Institute, University of Buffalo Jacobi Medical Center, Buffalo, NY, USA
| | - Liina Poder
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Michelle Sakala
- Department of Radiology, Michigan Medicine (University of Michigan), Ann Arbor, MI, USA
| | - Anuradha S Shenoy-Bhangle
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Myles T Taffel
- Department of Radiology, New York University Langone Health, 660 1st Ave, 3rd Floor, New York, NY, 10016, USA
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8
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Hindman N, VanBuren W. Imaging Spectrum of Endometriosis (Endometriomas to Deep Infiltrative Endometriosis). Radiol Clin North Am 2020; 58:275-289. [DOI: 10.1016/j.rcl.2019.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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9
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Allègre L, Aristizabal P, Nyangoh Timoh K, Thomassin-Naggara I, Kermarrec E, Bendifallah S, Darai E. Comparison of 3-Tesla to 1.5-Tesla Magnetic Resonance Enterography to assess multifocal and multicentric bowel endometriosis: Results in routine practice. Eur J Obstet Gynecol Reprod Biol 2018; 230:172-177. [DOI: 10.1016/j.ejogrb.2018.09.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/18/2018] [Accepted: 09/22/2018] [Indexed: 01/07/2023]
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Kim A, Fernandez P, Martin B, Palazzo L, Ribeiro-Parenti L, Walker F, Bucau M, Collinot H, Luton D, Koskas M. Magnetic Resonance Imaging Compared with Rectal Endoscopic Sonography for the Prediction of Infiltration Depth in Colorectal Endometriosis. J Minim Invasive Gynecol 2017; 24:1218-1226. [PMID: 28802956 DOI: 10.1016/j.jmig.2017.07.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 07/09/2017] [Accepted: 07/13/2017] [Indexed: 12/21/2022]
Abstract
STUDY OBJECTIVE To compare the accuracies of magnetic resonance imaging (MRI) and rectal endoscopic sonography (RES) in the prediction of the infiltration depth of colorectal endometriosis. DESIGN A retrospective cohort study (Canadian Task Force classification II-2). SETTING A university teaching hospital. PATIENTS Forty patients with symptomatic deep infiltrating endometriosis (DIE) of the rectum who underwent colorectal resection were included. INTERVENTIONS All patients underwent abdominopelvic MRI and RES preoperatively to assess the infiltration depth of colorectal endometriosis, and segmental resection of the rectosigmoid by laparoscopy was performed if RES showed bowel invasion. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive and negative likelihood ratios (LRs), and intermethod agreement were calculated for DIE muscularis and submucosal/mucosal infiltration confirmed by histopathological analysis. MEASUREMENTS AND MAIN RESULTS For MRI detection of DIE muscularis infiltration, the sensitivity, specificity, PPV, NPV, and negative LR were 68%, 100%, 100%, 20%, and 0.32, respectively. For the MRI detection of DIE submucosal/mucosal involvement, the sensitivity, specificity, PPV, NPV, and positive and negative LRs were 47%, 81%, 69%, 63%, 2.49, and 0.65, respectively. The PPV of RES detection of DIE muscularis infiltration was 93%. For the RES detection of DIE submucosal/mucosal layers, the sensitivity, specificity, PPV, NPV, and positive and negative LRs were 79%, 48%, 58%, 71%, 1.51, and 0.44, respectively. CONCLUSION In the current study, MRI is valuable for detecting endometriosis of the rectum but is less accurate in detecting submucosal/mucosal involvement than RES. Magnetic resonance imaging was not successful for preoperative determination of segmental resection versus a more conservative approach. When bowel involvement is detected by MRI, RES is not essential. When symptoms suggest DIE in patients without intestinal lesions detected by MRI, RES is necessary to exclude bowel invasion.
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Affiliation(s)
- Arane Kim
- Department of Obstetrics and Gynecology, Bichat Hospital, Paris, France.
| | | | | | | | | | | | - Margot Bucau
- Department of Pathology, Bichat Hospital, Paris, France
| | - Helene Collinot
- Department of Obstetrics and Gynecology, Bichat Hospital, Paris, France
| | - Dominique Luton
- Department of Obstetrics and Gynecology, Bichat Hospital, Paris, France
| | - Martin Koskas
- Department of Obstetrics and Gynecology, Bichat Hospital, Paris, France; Paris Diderot University, Paris, France
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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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Nisenblat V, Bossuyt PMM, Farquhar C, Johnson N, Hull ML. Imaging modalities for the non-invasive diagnosis of endometriosis. Cochrane Database Syst Rev 2016; 2:CD009591. [PMID: 26919512 PMCID: PMC7100540 DOI: 10.1002/14651858.cd009591.pub2] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND About 10% of women of reproductive age suffer from endometriosis. Endometriosis is a costly chronic disease that causes pelvic pain and subfertility. Laparoscopy, the gold standard diagnostic test for endometriosis, is expensive and carries surgical risks. Currently, no non-invasive tests that can be used to accurately diagnose endometriosis are available in clinical practice. This is the first review of diagnostic test accuracy of imaging tests for endometriosis that uses Cochrane methods to provide an update on the rapidly expanding literature in this field. OBJECTIVES • To provide estimates of the diagnostic accuracy of imaging modalities for the diagnosis of pelvic endometriosis, ovarian endometriosis and deeply infiltrating endometriosis (DIE) versus surgical diagnosis as a reference standard.• To describe performance of imaging tests for mapping of deep endometriotic lesions in the pelvis at specific anatomical sites.Imaging tests were evaluated as replacement tests for diagnostic surgery and as triage tests that would assist decision making regarding diagnostic surgery for endometriosis. SEARCH METHODS We searched the following databases to 20 April 2015: MEDLINE, CENTRAL, EMBASE, CINAHL, PsycINFO, Web of Science, LILACS, OAIster, TRIP, ClinicalTrials.gov, MEDION, DARE, and PubMed. Searches were not restricted to a particular study design or language nor to specific publication dates. The search strategy incorporated words in the title, abstracts, text words across the record and medical subject headings (MeSH). SELECTION CRITERIA We considered published peer-reviewed cross-sectional studies and randomised controlled trials of any size that included prospectively recruited women of reproductive age suspected of having one or more of the following target conditions: endometrioma, pelvic endometriosis, DIE or endometriotic lesions at specific intrapelvic anatomical locations. We included studies that compared the diagnostic test accuracy of one or more imaging modalities versus findings of surgical visualisation of endometriotic lesions. DATA COLLECTION AND ANALYSIS Two review authors independently collected and performed a quality assessment of data from each study. For each imaging test, data were classified as positive or negative for surgical detection of endometriosis, and sensitivity and specificity estimates were calculated. If two or more tests were evaluated in the same cohort, each was considered as a separate data set. We used the bivariate model to obtain pooled estimates of sensitivity and specificity when sufficient data sets were available. Predetermined criteria for a clinically useful imaging test to replace diagnostic surgery included sensitivity ≥ 94% and specificity ≥ 79%. Criteria for triage tests were set at sensitivity ≥ 95% and specificity ≥ 50%, ruling out the diagnosis with a negative result (SnNout test - if sensitivity is high, a negative test rules out pathology) or at sensitivity ≥ 50% with specificity ≥ 95%, ruling in the diagnosis with a positive result (SpPin test - if specificity is high, a positive test rules in pathology). MAIN RESULTS We included 49 studies involving 4807 women: 13 studies evaluated pelvic endometriosis, 10 endometriomas and 15 DIE, and 33 studies addressed endometriosis at specific anatomical sites. Most studies were of poor methodological quality. The most studied modalities were transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI), with outcome measures commonly demonstrating diversity in diagnostic estimates; however, sources of heterogeneity could not be reliably determined. No imaging test met the criteria for a replacement or triage test for detecting pelvic endometriosis, albeit TVUS approached the criteria for a SpPin triage test. For endometrioma, TVUS (eight studies, 765 participants; sensitivity 0.93 (95% confidence interval (CI) 0.87, 0.99), specificity 0.96 (95% CI 0.92, 0.99)) qualified as a SpPin triage test and approached the criteria for a replacement and SnNout triage test, whereas MRI (three studies, 179 participants; sensitivity 0.95 (95% CI 0.90, 1.00), specificity 0.91 (95% CI 0.86, 0.97)) met the criteria for a replacement and SnNout triage test and approached the criteria for a SpPin test. For DIE, TVUS (nine studies, 12 data sets, 934 participants; sensitivity 0.79 (95% CI 0.69, 0.89) and specificity 0.94 (95% CI 0.88, 1.00)) approached the criteria for a SpPin triage test, and MRI (six studies, seven data sets, 266 participants; sensitivity 0.94 (95% CI 0.90, 0.97), specificity 0.77 (95% CI 0.44, 1.00)) approached the criteria for a replacement and SnNout triage test. Other imaging tests assessed in small individual studies could not be statistically evaluated.TVUS met the criteria for a SpPin triage test in mapping DIE to uterosacral ligaments, rectovaginal septum, vaginal wall, pouch of Douglas (POD) and rectosigmoid. MRI met the criteria for a SpPin triage test for POD and vaginal and rectosigmoid endometriosis. Transrectal ultrasonography (TRUS) might qualify as a SpPin triage test for rectosigmoid involvement but could not be adequately assessed for other anatomical sites because heterogeneous data were scant. Multi-detector computerised tomography enema (MDCT-e) displayed the highest diagnostic performance for rectosigmoid and other bowel endometriosis and met the criteria for both SpPin and SnNout triage tests, but studies were too few to provide meaningful results.Diagnostic accuracies were higher for TVUS with bowel preparation (TVUS-BP) and rectal water contrast (RWC-TVS) and for 3.0TMRI than for conventional methods, although the paucity of studies precluded statistical evaluation. AUTHORS' CONCLUSIONS None of the evaluated imaging modalities were able to detect overall pelvic endometriosis with enough accuracy that they would be suggested to replace surgery. Specifically for endometrioma, TVUS qualified as a SpPin triage test. MRI displayed sufficient accuracy to suggest utility as a replacement test, but the data were too scant to permit meaningful conclusions. TVUS could be used clinically to identify additional anatomical sites of DIE compared with MRI, thus facilitating preoperative planning. Rectosigmoid endometriosis was the only site that could be accurately mapped by using TVUS, TRUS, MRI or MDCT-e. Studies evaluating recent advances in imaging modalities such as TVUS-BP, RWC-TVS, 3.0TMRI and MDCT-e were observed to have high diagnostic accuracies but were too few to allow prudent evaluation of their diagnostic role. In view of the low quality of most of the included studies, the findings of this review should be interpreted with caution. Future well-designed diagnostic studies undertaken to compare imaging tests for diagnostic test accuracy and costs are recommended.
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Affiliation(s)
- Vicki Nisenblat
- The University of AdelaideDiscipline of Obstetrics and Gynaecology, School of Medicine, Robinson Research InstituteLevel 6, Medical School North,Frome RdAdelaideSAAustralia5005
| | - Patrick MM Bossuyt
- Academic Medical Center, University of AmsterdamDepartment of Clinical Epidemiology, Biostatistics and BioinformaticsRoom J1b‐217, PO Box 22700AmsterdamNetherlands1100 DE
| | - Cindy Farquhar
- University of AucklandDepartment of Obstetrics and GynaecologyFMHS Park RoadGraftonAucklandNew Zealand1003
| | - Neil Johnson
- The University of AdelaideDiscipline of Obstetrics and Gynaecology, School of Medicine, Robinson Research InstituteLevel 6, Medical School North,Frome RdAdelaideSAAustralia5005
| | - M Louise Hull
- The University of AdelaideDiscipline of Obstetrics and Gynaecology, School of Medicine, Robinson Research InstituteLevel 6, Medical School North,Frome RdAdelaideSAAustralia5005
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Contribution of Computed Tomography Enema and Magnetic Resonance Imaging to Diagnose Multifocal and Multicentric Bowel Lesions in Patients With Colorectal Endometriosis. J Minim Invasive Gynecol 2015; 22:776-84. [DOI: 10.1016/j.jmig.2015.02.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 02/25/2015] [Accepted: 02/26/2015] [Indexed: 01/07/2023]
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