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Neme GL, Guimarães CTS, Dantas PP, Santana DDB, Yamauchi FI, Filho HML, Bittencourt LK, Pereira RMA, Mattos LA. Postoperative Imaging of Endometriosis. Radiographics 2024; 44:e230159. [PMID: 38512726 DOI: 10.1148/rg.230159] [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: 03/23/2024]
Abstract
Endometriosis is a highly prevalent disease that affects 10%-15% of women of reproductive age worldwide and is mainly associated with chronic pelvic pain and infertility. With the widespread use of imaging for the diagnosis and monitoring of endometriosis, combined with the ability of surgery to eradicate the disease and address infertility, there has been a significant increase in recent years in imaging examinations for postoperative evaluation of endometriosis. US and MRI are used not only to help diagnose and map endometriosis but also to evaluate refractory symptoms, residual lesions, and complications at posttreatment assessment. Knowledge of surgical techniques and recognition of expected postoperative imaging findings are crucial to differentiate postoperative changes from residual disease and/or recurrence. The authors discuss imaging aspects of postoperative endometriosis, with an emphasis on the imaging approach, comprehension of surgical techniques, recognition of the expected findings, possible complications, and analysis of residual disease or recurrence. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material. See the invited commentary by VanBuren in this issue. The slide presentation from the RSNA Annual Meeting is available for this article.
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Affiliation(s)
- Glaucy L Neme
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil (G.L.N., C.T.S.G., D.D.B.S., F.I.Y., H.M.L.F., L.A.M.); Department of Radiology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil (P.P.D.); Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (L.K.B.); and Center of Endometriosis, Santa Joana Hospital, São Paulo, Brazil (R.M.A.P.)
| | - Cassia T S Guimarães
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil (G.L.N., C.T.S.G., D.D.B.S., F.I.Y., H.M.L.F., L.A.M.); Department of Radiology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil (P.P.D.); Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (L.K.B.); and Center of Endometriosis, Santa Joana Hospital, São Paulo, Brazil (R.M.A.P.)
| | - Patricia P Dantas
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil (G.L.N., C.T.S.G., D.D.B.S., F.I.Y., H.M.L.F., L.A.M.); Department of Radiology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil (P.P.D.); Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (L.K.B.); and Center of Endometriosis, Santa Joana Hospital, São Paulo, Brazil (R.M.A.P.)
| | - Daniel D B Santana
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil (G.L.N., C.T.S.G., D.D.B.S., F.I.Y., H.M.L.F., L.A.M.); Department of Radiology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil (P.P.D.); Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (L.K.B.); and Center of Endometriosis, Santa Joana Hospital, São Paulo, Brazil (R.M.A.P.)
| | - Fernando I Yamauchi
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil (G.L.N., C.T.S.G., D.D.B.S., F.I.Y., H.M.L.F., L.A.M.); Department of Radiology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil (P.P.D.); Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (L.K.B.); and Center of Endometriosis, Santa Joana Hospital, São Paulo, Brazil (R.M.A.P.)
| | - Hilton M Leão Filho
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil (G.L.N., C.T.S.G., D.D.B.S., F.I.Y., H.M.L.F., L.A.M.); Department of Radiology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil (P.P.D.); Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (L.K.B.); and Center of Endometriosis, Santa Joana Hospital, São Paulo, Brazil (R.M.A.P.)
| | - Leonardo K Bittencourt
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil (G.L.N., C.T.S.G., D.D.B.S., F.I.Y., H.M.L.F., L.A.M.); Department of Radiology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil (P.P.D.); Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (L.K.B.); and Center of Endometriosis, Santa Joana Hospital, São Paulo, Brazil (R.M.A.P.)
| | - Ricardo M A Pereira
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil (G.L.N., C.T.S.G., D.D.B.S., F.I.Y., H.M.L.F., L.A.M.); Department of Radiology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil (P.P.D.); Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (L.K.B.); and Center of Endometriosis, Santa Joana Hospital, São Paulo, Brazil (R.M.A.P.)
| | - Leandro A Mattos
- From the Department of Radiology, Diagnósticos da América SA (DASA), Av Juruá 434, Alphaville Industrial, Barueri, SP 06455-010, Brazil (G.L.N., C.T.S.G., D.D.B.S., F.I.Y., H.M.L.F., L.A.M.); Department of Radiology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil (P.P.D.); Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio (L.K.B.); and Center of Endometriosis, Santa Joana Hospital, São Paulo, Brazil (R.M.A.P.)
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Young SW, Jha P, Chamié L, Rodgers S, Kho RM, Horrow MM, Glanc P, Feldman M, Groszmann Y, Khan Z, Young SL, Poder L, Burnett TL, Hu EM, Egan S, VanBuren W. Society of Radiologists in Ultrasound Consensus on Routine Pelvic US for Endometriosis. Radiology 2024; 311:e232191. [PMID: 38591980 PMCID: PMC11070694 DOI: 10.1148/radiol.232191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/21/2023] [Accepted: 12/22/2023] [Indexed: 04/10/2024]
Abstract
Endometriosis is a prevalent and potentially debilitating condition that mostly affects individuals of reproductive age, and often has a substantial diagnostic delay. US is usually the first-line imaging modality used when patients report chronic pelvic pain or have issues of infertility, both common symptoms of endometriosis. Other than the visualization of an endometrioma, sonologists frequently do not appreciate endometriosis on routine transvaginal US images. Given a substantial body of literature describing techniques to depict endometriosis at US, the Society of Radiologists in Ultrasound convened a multidisciplinary panel of experts to make recommendations aimed at improving the screening process for endometriosis. The panel was composed of experts in the imaging and management of endometriosis, including radiologists, sonographers, gynecologists, reproductive endocrinologists, and minimally invasive gynecologic surgeons. A comprehensive literature review combined with a modified Delphi technique achieved a consensus. This statement defines the targeted screening population, describes techniques for augmenting pelvic US, establishes direct and indirect observations for endometriosis at US, creates an observational grading and reporting system, and makes recommendations for additional imaging and patient management. The panel recommends transvaginal US of the posterior compartment, observation of the relative positioning of the uterus and ovaries, and the uterine sliding sign maneuver to improve the detection of endometriosis. These additional techniques can be performed in 5 minutes or less and could ultimately decrease the delay of an endometriosis diagnosis in at-risk patients.
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Affiliation(s)
| | | | - Luciana Chamié
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Shuchi Rodgers
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Rosanne M. Kho
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Mindy M. Horrow
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Phyllis Glanc
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Myra Feldman
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Yvette Groszmann
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Zaraq Khan
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Steven L. Young
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Liina Poder
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Tatnai L. Burnett
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Eric M. Hu
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Susan Egan
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
| | - Wendaline VanBuren
- From the Department of Radiology, Mayo Clinic Arizona, 5777 E Mayo
Blvd, Phoenix, AZ 85054 (S.W.Y.); Department of Radiology, Stanford University
School of Medicine, Stanford, Calif (P.J.); Department of Radiology,
Chamié Imagem da Mulher, São Paulo, Brazil (L.C.); Department of
Radiology, Albert Einstein Medical Center, Philadelphia, Pa (S.R., M.M.H.);
Department of Obstetrics and Gynecology, Banner Health System, Phoenix, Ariz
(R.M.K.); Department of Medical Imaging, University of Toronto, Toronto, Canada
(P.G.); Imaging Institute, Cleveland Clinic Foundation, Cleveland, Ohio (M.F.);
Department of Obstetrics and Gynecology, Brigham and Women’s Hospital,
Boston, Mass (Y.G.); Department of Obstetrics and Gynecology (Z.K., T.L.B.) and
Department of Radiology (W.V.B.), Mayo Clinic, Rochester, Minn; Department of
Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
(S.L.Y.); Department of Radiology and Biomedical Imaging, University of
California, San Francisco, San Francisco, Calif (L.P.); Department of Radiology,
Intermountain Healthcare, Salt Lake City, Utah (E.M.H.); and Department of
Radiology, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ
(S.E.)
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Maciel C, Ferreira H, Djokovic D, Kyaw Tun J, Keckstein J, Rizzo S, Manganaro L. MRI of endometriosis in correlation with the #Enzian classification: applicability and structured report. Insights Imaging 2023; 14:120. [PMID: 37405519 DOI: 10.1186/s13244-023-01466-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/14/2023] [Indexed: 07/06/2023] Open
Abstract
Endometriosis represents one of the most common causes of life-impacting chronic pelvic pain and female infertility. Magnetic resonance imaging (MRI) plays an increasing role in the diagnosis and mapping of endometriosis, while diagnostic laparoscopy currently tends to be reserved for the patients with negative imaging results. The #Enzian, published in 2021, proposes a new comprehensive classification system of endometriosis, combining a complete staging of deep infiltrative endometriosis with the evaluation of peritoneal/ovarian/tubal localizations and the presence of adenomyosis. This article addresses in detail the applicability of the #Enzian classification, primarily based on surgical findings, to the MRI evaluation of the endometriosis. Overall, there is a significant matching between MRI features and the #Enzian classification criteria, two different perspectives of endometriosis mapping, with different goals and levels of detail. The main discrepancy lies in the evaluation of tubo-ovarian condition, which is not fully assessable by MRI. Furthermore, as endometriosis is a complex disease, usually multifocal, that can present with a myriad of imaging findings, MRI reporting should be clear and well organized. The authors group, both radiologists and gynecologists, propose a structured MRI report of endometriosis in correlation with the #Enzian classification, merging the detailed anatomical and pre-operative information provided by the MRI with the benefits of a comprehensive classification system of endometriosis in the clinical practice and research field.Critical relevance statement This article addresses in detail the applicability of the #Enzian classification, primarily based on surgical findings, to the MRI evaluation of the endometriosis and proposes a #Enzian-based structured MRI report.
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Affiliation(s)
- Cristina Maciel
- Serviço de Radiologia, Centro Hospitalar Universitário São João, Porto, Portugal.
- Departamento de Medicina, Faculdade de Medicina, Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
| | - Hélder Ferreira
- Serviço de Ginecologia, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Largo do Prof. Abel Salazar, 4099-001, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Rua de Jorge Viterbo Ferreira, 228, 4050-313, Porto, Portugal
| | - Dusan Djokovic
- Maternidade Dr. Alfredo da Costa, Centro Hospitalar Universitário Lisboa Central (CHULC), Lisbon, Portugal
- Department of Obstetrics and Gynecology, NOVA Medical School - Faculdade de Ciências Médicas, NOVA University of Lisbon, Lisbon, Portugal
- Department of Obstetrics and Gynecology, Hospital CUF Descobertas, Lisbon, Portugal
| | - Jimmy Kyaw Tun
- Department of Interventional Radiology, The Royal London Hospital, Barts Health NHS Trust, London, E1 1BB, UK
| | - Jörg Keckstein
- Scientific Endometriosis Foundation (Stiftung Endometrioseforschung/SEF), Westerstede, Germany
- Endometriosis Clinic Dres. Keckstein, Villach, Austria
- University of Ulm, Ulm, Germany
| | - Stefania Rizzo
- Service of Radiology, Imaging Institute of Southern Switzerland, EOC, Via Tesserete 46, 6900, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Via G. Buffi 13, 6900, Lugano, Switzerland
| | - Lucia Manganaro
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
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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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Expert opinion on the use of transvaginal sonography for presurgical staging and classification of endometriosis. Arch Gynecol Obstet 2023; 307:5-19. [PMID: 36367580 PMCID: PMC9837004 DOI: 10.1007/s00404-022-06766-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 08/19/2022] [Indexed: 11/13/2022]
Abstract
Gynecological ultrasonography plays a central role in the management of endometriosis. The rapid technical development as well as the currently increasing evidence for non-invasive diagnostic methods require an updated compilation of recommendations for the use of ultrasound in the management of endometriosis. The present work aims to highlight the accuracy of sonography for diagnosing and classifying endometriosis and will formulate the present list of key messages and recommendations. This paper aims to demonstrate the accuracy of TVS in the diagnosis and classification of endometriosis and to discuss the clinical applications and consequences of TVS findings for indication, surgical planning and assessment of associated risk factors. (1) Sophisticated ultrasound is the primary imaging modality recommended for suspected endometriosis. The examination procedure should be performed according to the IDEA Consensus. (2) Surgical intervention to confirm the diagnosis alone is not recommended. A preoperative imaging procedure with TVS and/or MRI is strongly recommended. (3) Ultrasound examination does not allow the definitive exclusion of endometriosis. (4) The examination is primarily transvaginal and should always be combined with a speculum and a bimanual examination. (5) Additional transabdominal ultrasonography may enhance the accuracy of the examination in case of extra pelvic disease, extensive findings or limited transvaginal access. (6) Sonographic assessment of both kidneys is mandatory when deep endometriosis (DE) and endometrioma are suspected. (7) Endometriomas are well defined by sonographic criteria. When evaluating the ovaries, the use of IOTA criteria is recommended. (8) The description of sonographic findings of deep endometriosis should be systematically recorded and performed using IDEA terminology. (9) Adenomyosis uteri has sonographically well-defined criteria (MUSA) that allow for detection with high sensitivity and specificity. MRI is not superior to differentiated skilled ultrasonography. (10) Classification of the extent of findings should be done according to the #Enzian classification. The current data situation proves the best possible prediction of the intraoperative situs of endometriosis (exclusive peritoneum) for the non-invasive application of the #Enzian classification. (11) Transvaginal sonographic examination by an experienced examiner is not inferior to MRI diagnostics regarding sensitivity and specificity in the prediction of the extent of deep endometriosis. (12) The major advantage of non-invasive imaging and classification of endometriosis is the differentiated planning or possible avoidance of surgical interventions. The recommendations represent the opinion of experts in the field of non-invasive and invasive diagnostics as well as therapy of endometriosis. They were developed with the participation of the following national and international societies: DEGUM, ÖGUM, SGUM, SEF, AGEM/DGGG, and EEL.
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Hoopmann M, Tutschek B, Merz E, Eichhorn KH, Kagan KO, Heling KS, Faber R, Rempen A, Kaehler C, Manegold-Brauer G, Helmy S, Klaritsch P, Grab D. Quality Requirements for gynecological ultrasound examinations of DEGUM level II - Recommendations of the Sections/Working Groups Gynecology and Obstetrics of DEGUM, ÖGUM and SGUM. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:146-158. [PMID: 34749404 DOI: 10.1055/a-1663-6322] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Gynecological sonography is the central and most frequently used technical examination method used by gynecologists. Its focus is on the clarification of masses of the uterus and the adnexa, fertility diagnosis, clarification of bleeding disorders and chronic and acute pelvic problems, pelvic floor and incontinence diagnosis as well as the differential diagnosis of disturbed early pregnancy. The indication for diagnostic and therapeutic interventions, preoperative planning and postoperative controls are largely based on the findings of gynecological sonography. These examinations are particularly dependent on the experience of the examiner.Based on the proven multi-stage concept of obstetric diagnostics, gynecological sonography should primarily be performed by an experienced and specialized examiner in patients for whom the initial gynecological examinations have not yet led to a sufficient assessment of the findings. So that the expert status required for this has an objective basis, the Gynecology and Obstetrics Section of DEGUM in cooperation with ÖGUM and SGUM implemented the option of acquiring DEGUM Level II for gynecological sonography. The effectiveness of the care in the multi-level concept depends on the quality of the ultrasound examination at level I. Quality requirements for the basic examination and the differentiation between the basic and further examination have therefore already been defined by DEGUM/ÖGUM. The present work is intended to set out quality requirements for gynecological sonography of DEGUM level II and for the correspondingly certified gynecologists.Common pathologies from gynecological sonography and requirements for imaging and documentation are described.
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Affiliation(s)
- Markus Hoopmann
- Department of Obstetrics and Gynaecology, University of Tübingen, Tübingen, Germany
| | | | - Eberhard Merz
- Centre for Ultrasound and Prenatal Medicine, Frankfurt/Main, Germany
| | | | - Karl Oliver Kagan
- Department of Obstetrics and Gynaecology, University of Tübingen, Tübingen, Germany
| | - Kai-Sven Heling
- Praxis, Prenatal Diagnosis and Human Genetics, Berlin, Germany
| | - Renaldo Faber
- Leipzig, Center of Prenatal Medicine, Leipzig, Germany
| | - Andreas Rempen
- Frauenklinik, Evangelisches Diakoniekrankenhaus, Schwäbisch-Hall, Germany
| | | | | | - Samir Helmy
- Department of Obstetrics and Gynecology, Medical University of Vienna, Austria
| | - Philipp Klaritsch
- Department of Obstetrics and Gynecology, Medical University Graz, Austria
| | - Dieter Grab
- Department of Obstetrics and Gynecology, University of Ulm, Germany
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Barbisan CC, Andres MP, Torres LR, Libânio BB, Torres US, D'Ippolito G, Racy DJ, Abrao MS. Structured MRI reporting increases completeness of radiological reports and requesting physicians' satisfaction in the diagnostic workup for pelvic endometriosis. Abdom Radiol (NY) 2021; 46:3342-3353. [PMID: 33625575 DOI: 10.1007/s00261-021-02966-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/13/2021] [Accepted: 01/16/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE MRI plays an important role in the diagnosis and surgical planning of pelvic endometriosis (PE), and imaging reports should contain all relevant information (completeness). As structured reports are being increasingly utilized, we aimed to evaluate whether structured MRI reporting increases the quality of reports regarding completeness and, consequently, their perceived value by gynecologists, in comparison to free-text reports. We also aimed to compare the diagnostic performance of both formats. METHODS We retrospectively included 28 consecutive women with histologically proven PE who underwent MRI within one month before surgery. Two abdominal radiologists (Rd1/Rd2, 3y/12y experience), blinded to clinical and surgical data, individually elaborated free-text reports and, four months later, structured reports. Completeness (defined as description of six key anatomical sites deemed essential for surgical planning in a consensus of four-blinded external experts) and diagnostic performance (sensitivity and specificity) by site (histology as reference) were compared between reports using the McNemar test. The satisfaction of gynecologists was compared using the marginal homogeneity test. RESULTS Structured reporting increased completeness for both Rd1 (rectosigmoid, retrocervical/uterosacral ligament, vagina, and ureter) and Rd2 (vagina, ureter, and bladder) (p < 0.05), without compromising sensitivity or specificity at any of the evaluated sites. Gynecologists' satisfaction was superior with structured reports in most comparisons. CONCLUSION Structured MRI reports perform better in fully documenting essential features of PE and are similar in terms of diagnostic performance, therefore having higher potential for surgical planning. Gynecologists found them easier to assess and were more satisfied with the information provided by structured reports.
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Affiliation(s)
| | - Marina Paula Andres
- BP- A Beneficência Portuguesa de São Paulo, São Paulo, Brazil
- Disciplina de Ginecologia, Departamento de Obstetrícia E Ginecologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Rua São Sebastião, 550, São Paulo, SP, 04708-001, Brazil
| | - Lucas R Torres
- BP- A Beneficência Portuguesa de São Paulo, São Paulo, Brazil
- Grupo Fleury, São Paulo, Brazil
| | - Bruna B Libânio
- BP- A Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | - Ulysses S Torres
- Grupo Fleury, São Paulo, Brazil
- Universidade Federal de São Paulo, São Paulo, Brazil
| | - Giuseppe D'Ippolito
- Grupo Fleury, São Paulo, Brazil
- Universidade Federal de São Paulo, São Paulo, Brazil
| | - Douglas J Racy
- BP- A Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | - Mauricio Simões Abrao
- BP- A Beneficência Portuguesa de São Paulo, São Paulo, Brazil.
- Disciplina de Ginecologia, Departamento de Obstetrícia E Ginecologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Rua São Sebastião, 550, São Paulo, SP, 04708-001, Brazil.
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Hausmann D, Perignon V, Grabherr R, Weiland E, Nickel MD, Murer M, Bosshard L, Prummer M, Kubik-Huch RA. Can Dynamic Contrast-enhanced MRI Contribute to Improved Assessment of Rectosigmoid Involvement in Deep Infiltrating Endometriosis? In Vivo 2021; 35:2217-2226. [PMID: 34182500 DOI: 10.21873/invivo.12494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/05/2021] [Accepted: 05/06/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM To determine whether a prototypical compressed-sensing volume-interpolated breath-hold (csVIBE) provides diagnostic value in detecting rectosigmoid infiltration in deep infiltrating endometriosis (DIE). PATIENTS AND METHODS csVIBE was employed in 151 women undergoing pelvic magnetic resonance imaging, of whom 43 had undergone surgery for suspected endometriosis. The accuracy of T2-weighted BLADE and BLADE/csVIBE, additional diagnostic value of csVIBE, and diagnostic confidence were rated by two readers. Additionally, the presence of the "mushroom cap sign" was assessed on BLADE and csVIBE. RESULTS The diagnostic accuracy, sensitivity, and specificity of BLADE and BLADE/csVIBE were not significantly different between Readers A and B. For both readers, the confidence in the diagnosis increased with csVIBE, but this increase in the odds ratio was not significant for both readers. Both readers preferred csVIBE over BLADE with regard to detection of the "mushroom cap sign." CONCLUSION csVIBE may provide a diagnostic benefit for surgical strategy selection through better delineation of the "mushroom cap sign."
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Affiliation(s)
- Daniel Hausmann
- Department of Radiology, Kantonsspital Baden, Baden, Switzerland; .,Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | - Regula Grabherr
- Department of Gynecology, Kantonsspital Baden, Baden, Switzerland
| | - Elisabeth Weiland
- MR Applications Predevelopment, Siemens Healthcare GmbH, Erlangen, Germany
| | | | - Maurus Murer
- Department of Pathology, Kantonsspital Baden, Baden, Switzerland
| | - Lars Bosshard
- Nexus Personalized Health Technologies, ETH Zurich, and Swiss Institute for Bioinformatics (SIB), Zurich, Switzerland
| | - Michael Prummer
- Nexus Personalized Health Technologies, ETH Zurich, and Swiss Institute for Bioinformatics (SIB), Zurich, Switzerland
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Djokovic D, Pinto P, van Herendael BJ, Laganà AS, Thomas V, Keckstein J. Structured report for dynamic ultrasonography in patients with suspected or known endometriosis: Recommendations of the International Society for Gynecologic Endoscopy (ISGE). Eur J Obstet Gynecol Reprod Biol 2021; 263:252-260. [PMID: 34242934 DOI: 10.1016/j.ejogrb.2021.06.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/07/2021] [Accepted: 06/22/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The International Society for Gynecologic Endoscopy (ISGE) developed this project to establish the recommendations for structured reporting of dynamic ultrasound findings, promoting on this manner the practice of standardized, comprehensive and systematic evaluation and reporting of endometriosis in pelvic structures, in correlation with the #Enzian classification. STUDY DESIGN A non-systematic review was done through a search on the following databases: MEDLINE, EMBASE, Global Health, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register), Health Technology Assessment Database and Web of Science, using the medical subject heading (MeSH) term "endometriosis" (MeSH Unique ID: D004715) in combination with "diagnostic imaging" (MeSH Unique ID Q000000981) and "consensus" (MeSH Unique ID D032921). The information extracted from the articles of interest, written in English and published from inception of the above-mentioned databases until May 2021, was graded by the level of evidence using the American College of Chest Physicians (ACCP) classification system. The recommendations for a structured reporting of ultrasound findings were developed through multiple cycles of literature analysis and expert discussion following the Delphi method. RESULTS The ISGE recommends the adoption of the terms, definitions and methods proposed by the International Deep Endometriosis Analysis (IDEA) Group for ultrasound assessment of patients with suspected or known endometriosis (grade 1C), since this is the most comprehensive and systematic concept currently available. This paper provides the ISGE structured reporting template for presenting quantitative and qualitative information upon the IDEA consensus-based sonographic assessment of the uterus, adnexa, anterior and posterior compartment. The #Enzian classification is recommended to summarize the findings in a standard fashion (grade 1B). CONCLUSION Mapping of pelvic endometriosis by ultrasound is accurate when trained sonographers perform the technique. Structured reporting of the lesions may improve patient counseling and treatment planning, including the organization of multidisciplinary teams and the selection of the most appropriate medical or surgical therapeutic strategy.
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Affiliation(s)
- Dusan Djokovic
- Maternidade Dr. Alfredo da Costa, Centro Hospitalar Universitário Lisboa Central (CHULC), Lisbon, Portugal; Department of Obstetrics and Gynecology, NOVA Medical School - Faculdade de Ciências Médicas, NOVA University of Lisbon, Lisbon, Portugal; Department of Obstetrics and Gynecology, Hospital CUF Descobertas, Lisbon, Portugal.
| | - Patrícia Pinto
- Maternidade Dr. Alfredo da Costa, Centro Hospitalar Universitário Lisboa Central (CHULC), Lisbon, Portugal; First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Bruno J van Herendael
- Department of Minimally Invasive Gynecologic Surgery, Stuivenberg General Hospital, Ziekenhuis Netwerk Antwerpen (ZNA), Antwerp, Belgium; Università degli Studi dell'Insubria, Varese, Italy
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Viju Thomas
- Department of Obstetrics and Gynecology, Tygerberg Hospital, University of Stellenbosch, Cape Town, South Africa
| | - Jörg Keckstein
- Scientific Endometriosis Foundation (Stiftung Endometrioseforschung/SEF), Westerstede, Germany; Endometriosis Clinic Dres. Keckstein, Villach, Austria; University of Ulm, Ulm, Germany
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10
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Stanzione A, Boccadifuoco F, Cuocolo R, Romeo V, Mainenti PP, Brunetti A, Maurea S. State of the art in abdominal MRI structured reporting: a review. Abdom Radiol (NY) 2021; 46:1218-1228. [PMID: 32936418 PMCID: PMC7940284 DOI: 10.1007/s00261-020-02744-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 08/27/2020] [Accepted: 09/03/2020] [Indexed: 12/13/2022]
Abstract
In the management of several abdominal disorders, magnetic resonance imaging (MRI) has the potential to significantly improve patient's outcome due to its diagnostic accuracy leading to more appropriate treatment choice. However, its clinical value heavily relies on the quality and quantity of diagnostic information that radiologists manage to convey through their reports. To solve issues such as ambiguity and lack of comprehensiveness that can occur with conventional narrative reports, the adoption of structured reporting has been proposed. Using a checklist and standardized lexicon, structured reports are designed to increase clarity while assuring that all key imaging findings related to a specific disorder are included. Unfortunately, structured reports have their limitations too, such as risk of undue report simplification and poor template plasticity. Their adoption is also far from widespread, and probably the ideal balance between radiologist autonomy and report consistency of has yet to be found. In this article, we aimed to provide an overview of structured reporting proposals for abdominal MRI and of works assessing its value in comparison to conventional free-text reporting. While for several abdominal disorders there are structured templates that have been endorsed by scientific societies and their adoption might be beneficial, stronger evidence confirming their imperativeness and added value in terms of clinical practice is needed, especially regarding the improvement of patient outcome.
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Affiliation(s)
- Arnaldo Stanzione
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Francesca Boccadifuoco
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Renato Cuocolo
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Via S. Pansini, 5, 80131, Naples, Italy.
| | - Valeria Romeo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Pier Paolo Mainenti
- Institute of Biostructures and Bioimaging, National Research Council, Naples, Italy
| | - Arturo Brunetti
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Simone Maurea
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
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Casals G, Carrera M, Domínguez JA, Abrão MS, Carmona F. Impact of Surgery for Deep Infiltrative Endometriosis before In Vitro Fertilization: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2021; 28:1303-1312.e5. [PMID: 33582380 DOI: 10.1016/j.jmig.2021.02.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/21/2021] [Accepted: 02/04/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The aims of this systematic review and meta-analysis were to compare reproductive outcomes in patients who underwent surgery for deep infiltrative endometriosis (DIE) before in vitro fertilization (IVF) with those in patients who underwent IVF without a previous surgery for DIE, to analyze data according to different types of surgery (complete or incomplete) or subgroups of patients (DIE with or without bowel involvement), and to assess surgical and IVF complications and data regarding safety concerns. DATA SOURCES A systematic literature search from January 1980 to November 2019 with no language restriction was performed in PubMed, MEDLINE, Embase, and Web of Science. The search strategy used the following Medical Subject Headings terms: "in vitro," "fertilization," "IVF," "assisted reproduction," "colorectal," "endometriosis," "deep," "infiltrating," "deep infiltrative endometriosis," "intestinal," "bowel," "rectovaginal," "uterosacral," "vaginal," and "bladder." METHODS OF STUDY SELECTION We included studies that compared reproductive outcomes in women with infertility with DIE who received IVF with or without a previous surgery for DIE lesions. Meta-analysis was performed using Review Manager (RevMan v.5.3; Cochrane Training, London, United Kingdom). The risk of bias of the included studies was assessed using the method recommended by Cochrane Collaboration. TABULATION, INTEGRATION, AND RESULTS The systematic search retrieved 150 articles; 98 studies were potentially eligible, and their full texts were reviewed. Of these, 12 studies met our inclusion criteria, and 5 presented data suitable for inclusion in a meta-analysis; however, 2 of the studies provided overlapping data, and only the larger study was finally included. No randomized controlled trials (RCTs) were found. The pregnancy rate per patient was 1.84 (95% confidence interval [CI], 1.28-2.64), the pregnancy rate per cycle was 1.84 (95% CI, 1.26-2.70), and the live birth rate per patient was 2.22 (95% CI, 1.42-3.46) times more likely for operated patients than for nonoperated ones. The addition of data from the incomplete surgery groups also showed a higher pregnancy rate per patient for surgery before IVF (odds ratio [OR] 1.63; 95% CI, 1.16-2.28). The results favor previous surgery in DIE with digestive involvement (OR 2.43; 95% CI, 1.13-5.22) and also in DIE without digestive involvement (OR 1.55; 95% CI, 0.61-3.95). A qualitative analysis of the complications of surgery and IVF showed a partial or complete lack of information on these issues as well as high heterogeneity in the reported data. None of these studies is an RCT; therefore, all have a high risk of selection and allocation bias, except for 1 study that statistically controlled the latter risk by using propensity scores. Funnel plots showed no asymmetry. CONCLUSION The results were very consistent for all the studied outcomes, showing a statistically significant benefit for surgery before IVF, although they should be confirmed with RCTs. In addition to the reproductive outcomes, safety data should also be reported to obtain a complete assessment of the risks and benefits.
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Affiliation(s)
- Gemma Casals
- Department of Gynecology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Faculty of Medicine, University of Barcelona (Drs. Casals and Carmona), Barcelona
| | - María Carrera
- Assisted Reproduction Unit, Hospital Universitario Doce de Octubre (Dr. Carrera), Madrid
| | - José Antonio Domínguez
- Instituto Extremeño de Reproducción Asistida (IERA Badajoz-Lisboa), Centro de Cirugía de Mínima Invasión Jesús Uson (Dr. Domínguez), Cáceres, Spain
| | - Mauricio Simões Abrão
- Gynecologic Division, BP-A Beneficencia Portuguesa de São Paulo, Department of Obstetrics and Gynecology, Faculdade de Medicina, Universidade de São Paulo (Dr. Abrão), São Paulo, Brazil
| | - Francisco Carmona
- Department of Gynecology, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Faculty of Medicine, University of Barcelona (Drs. Casals and Carmona), Barcelona.
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Cunha FLD, Arcoverde FVL, Andres MP, Gomes DC, Bautzer CRD, Abrao MS, Tobias-Machado M. Laparoscopic Treatment of Ureteral Endometriosis: A Systematic Review. J Minim Invasive Gynecol 2020; 28:779-787. [PMID: 33253957 DOI: 10.1016/j.jmig.2020.11.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To review the literature for the preoperative clinical characteristics, surgical findings, and outcomes of patients who underwent laparoscopic surgical treatment of ureteral endometriosis (UE). DATA SOURCES A systematic search was performed in the PubMed and Scopus databases. METHODS OF STUDY SELECTION Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, studies in English language that assessed UE treated surgically by laparoscopy published between 2008 and 2020 were selected. TABULATION, INTEGRATION, AND RESULTS In an initial search, 1313 articles were identified, 193 in PubMed and 1120 in Scopus databases. A total of 1291 articles that did not meet eligibility criteria were excluded. The remaining 22 studies were included in the final qualitative analysis, with a total of 1337 patients. Data on preoperative patient's characteristics, preoperative imaging examinations, intraoperative findings, and postoperative complications were abstracted by 1 author. The descriptive nature of included studies prevented the performance of meta-analysis. Preoperative symptoms included dysmenorrhea (76.3%), pelvic pain (59.6%), dyspareunia (46.2%), lower urinary tract symptoms (21.3%), and ureteral obstructive symptoms (9.9%). Intraoperative findings showed that UE lesions were left-sided in 55% of the cases, right-sided in 28.9% of the cases, and bilateral in 8.7% of the cases. Ureterolysis alone or before another technique was performed in 69.1% of the cases, ureteral resection followed by ureteroureteral anastomosis in 6%, ureteroneocystostomy after ureteral resection in 21%, and nephrectomy in 0.45% of the patients. Double-J ureteral stent placement was reported in 33.3% of the cases. Concomitant resection of the bladder owing to endometriosis involvement was performed in 15.5% of the cases. The prevalence of ureteral injury was 3.1%. Postoperative complications included ureteral fistula (2.8%), ureteral stenosis (24.2%), persistence/recurrence of UE (3.8%), and reoperation for fistula and/or stricture treatment (3.9%). CONCLUSION UE is associated with common endometriosis pain symptoms and a low rate of lower urinary tract symptoms. The standard surgical technique for UE treatment is not yet a consensus; however, the laparoscopic approach with previous ureterolysis, leaving ureteral resection only for refractory cases, seems to be a safe and effective treatment, with improvement of symptoms and few intraoperative and postoperative complications.
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Affiliation(s)
| | | | - Marina Paula Andres
- Gynecologic Division, Departamento de Obstetrícia e Ginecologia. Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo (Drs. Andres and Abrao); Gynecologic Division, Beneficência Portuguesa de São Paulo (Drs. Andres and Abrao)
| | - Daniel Coser Gomes
- Urology Division, Hospital Municipal Dr. José de Carvalho Florence, São José dos Campos (Dr. Gomes)
| | - Carlos Ricardo Doi Bautzer
- Urology Division, Hospital Sirio Libanês (Dr. Bautzer); Urology Division, ABC Medical School, Santo André (Drs. Bautzer and Tobias-Machado)
| | - Mauricio Simoes Abrao
- Gynecologic Division, Departamento de Obstetrícia e Ginecologia. Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo (Drs. Andres and Abrao); Gynecologic Division, Beneficência Portuguesa de São Paulo (Drs. Andres and Abrao).
| | - Marcos Tobias-Machado
- Instituto do Câncer, Dr. Arnaldo Vieira de Carvalho (Drs. da Cunha and Tobias-Machado); Urology Division, ABC Medical School, Santo André (Drs. Bautzer and Tobias-Machado); Hospital São Luiz Morumbi, Rede D´Or (Dr. Tobias-Machado), São Paulo
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13
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Guo SW, Martin DC. The perioperative period: a critical yet neglected time window for reducing the recurrence risk of endometriosis? Hum Reprod 2020; 34:1858-1865. [PMID: 31585460 DOI: 10.1093/humrep/dez187] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 07/11/2019] [Indexed: 12/11/2022] Open
Abstract
While surgery is commonly the management of symptomatic endometriosis when patients do not respond to medical or supportive therapy, recurrence after surgery poses a serious challenge, and repeat surgery increases the risk of premature ovarian failure, adhesion and organ injury. Conceivably, the recurrent endometriotic lesions could arise from minimal residual lesions (MRLs) or from de novo lesions. However, several lines of evidence suggest that the former is more likely. So far, most, if not all, efforts to combat recurrence have been focused on postoperative medication of hormonal drugs to reduce recurrence risk through lesional dormancy and possibly atrophy. However, the perioperative period may exert a disproportionally high impact on the risk of recurrence; it is likely to be amendable for possible intervention but has been generally neglected. Indeed, many perioperative factors are known to or conceivably could facilitate the recurrence of endometriosis through the suppression of cell-mediated immunity due to the activation of adrenergic signaling and the release of prostaglandins. Perioperative use of β-blockers and/or nuclear factor κB/jCycloxygenase 2 (NF-κB/COX-2) inhibitors may boost the cell-mediated immunity suppressed by surgery, resulting in the partial or even complete removal of MRLs and reduced recurrence risk. This is both biologically plausible and supported by a recent experimental study. We call for more research on possible perioperative interventions to reduce the recurrence risk of endometriosis. The potential payoff might be a substantial reduction in the risk of recurrence and cost when compared with the traditional approach of postoperative intervention.
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Affiliation(s)
- Sun-Wei Guo
- Shanghai OB/GYN Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Fudan University, Shanghai, China
| | - Dan C Martin
- School of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.,Institutional Review Board, Virginia Commonwealth University, Richmond, VA, USA
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14
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Jha P, Sakala M, Chamie LP, Feldman M, Hindman N, Huang C, Kilcoyne A, Laifer-Narin S, Nicola R, Poder L, Shenoy-Bhangle A, Tong A, VanBuren W, Taffel MT. Endometriosis MRI lexicon: consensus statement from the society of abdominal radiology endometriosis disease-focused panel. Abdom Radiol (NY) 2020; 45:1552-1568. [PMID: 31728612 DOI: 10.1007/s00261-019-02291-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [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 gynecologic disorder characterized by the presence of ectopic endometrial tissue outside the endometrial cavity. Magnetic Resonance Imaging (MRI) has become a mainstay for diagnosis and staging of this disease. In the literature, significant heterogeneity exists in the descriptions of imaging findings and anatomic sites of involvement. The Society of Abdominal Radiology's Endometriosis Disease-Focused Panel presents this consensus document to establish an MRI lexicon for endometriosis MRI evaluation and anatomic localization.
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Affiliation(s)
- Priyanka Jha
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, 505 Parnassus Ave, Box 0628, San Francisco, CA, USA.
| | - Michelle Sakala
- Department of Radiology, Michigan Medicine (University of Michigan), Ann Arbor, MI, USA
| | - Luciana Pardini Chamie
- 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 School of Medicine, New York, NY, USA
| | - Chenchan Huang
- Department of Radiology, New York University School of Medicine, New York, NY, USA
| | - Aoife Kilcoyne
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Sherelle Laifer-Narin
- Department of Radiology, Columbia University / New York Presbyterian Hospital, New York, NY, USA
| | - Refky Nicola
- Roswell Park Cancer Institute, Jacobs School of Medicine and Biomedical Science, University at Buffalo, Buffalo, NY, USA
| | - Liina Poder
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, 505 Parnassus Ave, Box 0628, San Francisco, CA, USA
| | - Anuradha Shenoy-Bhangle
- Division of Abdominal Imaging, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Angela Tong
- Department of Radiology, New York University School of Medicine, New York, NY, USA
| | - Wendy VanBuren
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Myles T Taffel
- Department of Radiology, New York University School of Medicine, New York, NY, USA
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15
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Hindman N, Eswar C, Huang K, Tong A. Medical management of endometriosis: what the radiologist needs to know. Abdom Radiol (NY) 2020; 45:1866-1871. [PMID: 32270260 DOI: 10.1007/s00261-020-02507-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The role of the radiologist in the diagnosis and management of patients with endometriosis is increasing. Improvement in MRI imaging techniques has improved detection rate of subtle manifestations of endometriosis by radiologists. Therefore, the role of imaging in the diagnosis and follow-up after treatment is also likely to increase. Knowledge of new medical management pathways used in treating patients with endometriosis-related pain is important. The knowledge of various medication regimens will allow radiologists to continue to evaluate baseline disease, and to potentially assess for imaging response/stability to these medications. This article will review the current medical therapies in use in the management of endometriosis-related pain and describe potential imaging-related findings expected with these therapies.
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Affiliation(s)
- Nicole Hindman
- NYU Radiology, NYU School of Medicine, 660 First Avenue, New York, NY, 10016, USA.
| | - Christopher Eswar
- NYU Obstetrics and Gynecology, NYU School of Medicine, 660 First Avenue, New York, NY, 10016, USA
| | - Kathy Huang
- NYU Obstetrics and Gynecology, NYU School of Medicine, 660 First Avenue, New York, NY, 10016, USA
| | - Angela Tong
- NYU Radiology, NYU School of Medicine, 660 First Avenue, New York, NY, 10016, USA
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16
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Abstract
Endovaginal sonographic imaging has been shown to reliably identify pelvic endometriosis, but most United States imaging practices do not adequately assess locations and features of endometriosis beyond ovarian endometrioma. In this article, we propose a protocol for sonographer-acquired images and maneuvers to be interpreted subsequently by sonologists (radiologists or gynecologists). The purpose is to improve the sensitivity of endovaginal sonography for the detection of endometriosis in imaging practices that involve the non-physician sonographer as part of their workflow.
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17
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Systematic interpretation and structured reporting for pelvic magnetic resonance imaging studies in patients with endometriosis: value added for improved patient care. Abdom Radiol (NY) 2020; 45:1608-1622. [PMID: 31446452 DOI: 10.1007/s00261-019-02182-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Endometriosis is a chronic, multifocal disease, which can lead to pain or subfertility. Treatments are tailored toward the therapeutic goals of the individual patient; either to improve a specific pain symptom or optimize fertility. Management of endometriosis is complex, and best implemented by a comprehensive, multidisciplinary team of physicians and health care providers. The role of the radiologist in the management of endometriosis is becoming increasingly important as more centers move toward utilizing female pelvic MR studies to diagnose, delineate or follow endometriosis lesions. The radiologist must communicate pertinent, actionable findings from these studies in a manner that is clear and concise. Structured radiologic reports (SRR) add value in that they provide organized, clear, and comprehensive information from imaging studies, ensuring reports include essential items required for decision-making. In this paper, we review our MR imaging protocol and present the structured radiologic report implemented at our institution by our multidisciplinary endometriosis care team. Imaging features of endometriosis at each site specified in the structured report are summarized. The importance of each element included in the structured report from a management perspective is highlighted.
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18
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Chamié LP. Ultrasound evaluation of deeply infiltrative endometriosis: technique and interpretation. Abdom Radiol (NY) 2020; 45:1648-1658. [PMID: 31740997 DOI: 10.1007/s00261-019-02322-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Endometriosis is a common benign gynecological condition defined as the presence of endometrial tissue located outside the uterus and frequently associated with chronic pelvic pain and infertility. It is a polymorphic disease that can be presented as superficial implants, endometriomas and deep lesions that infiltrate the peritoneal surface associated with fibrosis and inflammatory reaction. Diagnosis of deep endometriosis is difficult and delayed, frequently missed in a routine ultrasound. Transvaginal ultrasound is the first-line imaging modality to investigate endometriosis and when performed by an expert in female pelvic imaging can provide a reliable mapping of the affected sites. Bowel preparation can be used to improve the detection of bowel lesions as well as the other sites affected by eliminating artifacts. Surgery has been the mainstay to treat symptomatic endometriosis and preoperative imaging mapping is crucial for better results and to reduce residual disease. The goals of surgery include radical removal of all lesions and the restoration of normal pelvic anatomy. The author describes technical aspects and imaging interpretation of the transvaginal sonography to investigate deeply infiltrative endometriosis.
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Affiliation(s)
- Luciana Pardini Chamié
- Department of Diagnostic Imaging, Chamié Imagem da Mulher, Rua Casa do Ator, 1117, cj 72, São Paulo, São Paulo, 04546-004, Brazil.
- Department of Diagnostic Imaging, Fleury Medicina e Saúde, São Paulo, São Paulo, Brazil.
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19
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Diagnosing endometriosis before laparoscopy: radiologic tools to evaluate the disease. Curr Opin Obstet Gynecol 2020; 32:292-297. [DOI: 10.1097/gco.0000000000000638] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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