1
|
Takeuchi M, Matsuzaki K, Harada M. Endometriosis, a common but enigmatic disease with many faces: current concept of pathophysiology, and diagnostic strategy. Jpn J Radiol 2024; 42:801-819. [PMID: 38658503 PMCID: PMC11286651 DOI: 10.1007/s11604-024-01569-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/06/2024] [Indexed: 04/26/2024]
Abstract
Endometriosis is a benign, common, but controversial disease due to its enigmatic etiopathogenesis and biological behavior. Recent studies suggest multiple genetic, and environmental factors may affect its onset and development. Genomic analysis revealed the presence of cancer-associated gene mutations, which may reflect the neoplastic aspect of endometriosis. The management has changed dramatically with the development of fertility-preserving, minimally invasive therapies. Diagnostic strategies based on these recent basic and clinical findings are reviewed. With a focus on the presentation of clinical cases, we discuss the imaging manifestations of endometriomas, deep endometriosis, less common site and rare site endometriosis, various complications, endometriosis-associated tumor-like lesions, and malignant transformation, with pathophysiologic conditions.
Collapse
Affiliation(s)
- Mayumi Takeuchi
- Department of Radiology, Tokushima University, 3-18-15, Kuramoto-Cho, Tokushima, 7708503, Japan.
| | - Kenji Matsuzaki
- Department of Radiological Technology, Tokushima Bunri University, Sanuki City, ShidoKagawa, 1314-17692193, Japan
| | - Masafumi Harada
- Department of Radiology, Tokushima University, 3-18-15, Kuramoto-Cho, Tokushima, 7708503, Japan
| |
Collapse
|
2
|
Bourdon M, Sorel M, Maignien C, Guibourdenche J, Patrat C, Marcellin L, Jobin T, Chapron C, Santulli P. Progesterone levels do not differ between patients with or without endometriosis/adenomyosis both in those who conceive after hormone replacement therapy-frozen embryo transfer cycles and those who do not. Hum Reprod 2024; 39:1692-1700. [PMID: 38850031 DOI: 10.1093/humrep/deae114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 04/19/2024] [Indexed: 06/09/2024] Open
Abstract
STUDY QUESTION Do women with endometriosis who achieve a live birth (LB) after HRT-frozen embryo transfer (HRT-FET) have different progesterone levels on the day of transfer compared to unaffected women? SUMMARY ANSWER In women achieving a LB after HRT-FET, serum progesterone levels on the day of the transfer did not differ between patients with endometriosis and unaffected patients. WHAT IS KNOWN ALREADY In HRT-FET, several studies have highlighted the correlation between serum progesterone levels at the time of FET and LB rates. In the pathophysiology of endometriosis, progesterone resistance is typically described in the eutopic endometrium. This has led to the hypothesis that women with endometriosis may require higher progesterone levels to achieve a LB, especially in HRT-FET cycles without a corpus luteum. STUDY DESIGN, SIZE, DURATION We conducted an observational cohort study at the university-based reproductive medicine center of our institution, focusing on women who underwent a single autologous frozen blastocyst transfer after HRT using exogenous estradiol and micronized vaginal progesterone for endometrial preparation between January 2019 and December 2021. Women were included only once during the study period. Serum progesterone levels were measured on the morning of the FET by a single laboratory. PARTICIPANTS/MATERIALS, SETTING, METHODS Patients were divided into groups based on whether they had endometriosis or not and whether they achieved a LB. The diagnosis of endometriosis was based on published imaging criteria (transvaginal sonography/magnetic resonance imaging) and/or confirmed histology. The primary outcome was progesterone levels on the day of the HRT-FET leading to a LB in patients with endometriosis compared to unaffected women. Subgroup analyses were performed based on the presence of deep infiltrating endometriosis or adenomyosis. MAIN RESULTS AND THE ROLE OF CHANCE A total of 1784 patients were included. The mean age of the women was 35.1 ± 4.1 (SD) years. Five hundred and sixty women had endometriosis, while 1224 did not. About 179/560 (32.0%) with endometriosis and 381/1224 (31.2%) without endometriosis achieved a LB. Among women who achieved a LB after HRT-FET, there was no significant difference in the mean progesterone level on the day of the HRT-FET between those with endometriosis and those without (13.6 ± 4.3 ng/ml vs 13.2 ± 4.4 ng/ml, respectively; P = 0.302). In the subgroup of women with deep infiltrating endometriosis (n = 142) and adenomyosis (n = 100), the mean progesterone level was 13.1 ± 4.1 ng/ml and 12.6 ± 3.7 ng/ml, respectively, with no significant difference compared to endometriosis-free patients. After adjusting for BMI, parity, duration of infertility, tobacco use, and geographic origin, neither the presence of endometriosis (coefficient 0.38; 95% CI: -0.63 to 1.40; P = 0.457) nor the presence of adenomyosis (coefficient 0.97; 95% CI: -0.24 to 2.19; P = 0.114) was associated with the progesterone level on the day of HRT-FET. Among women who did not conceive, there was no significant difference in the mean progesterone level on the day of the HRT-FET between those with endometriosis and those without (P = 0.709). LIMITATIONS, REASONS FOR CAUTION The primary limitation of our study is associated with its observational design. Extrapolating our results to other laboratories or different routes and/or dosages of administering progesterone also requires validation. WIDER IMPLICATIONS OF THE FINDINGS This study shows that patients diagnosed with endometriosis do not require higher progesterone levels on the day of a frozen blastocyst transfer to achieve a LB in hormonal replacement therapy cycles. STUDY FUNDING/COMPETING INTEREST(S) None declared. TRIAL REGISTRATION NUMBER N/A.
Collapse
Affiliation(s)
- M Bourdon
- Faculté de Santé, University of Paris Cité, Paris, France
- Department of Gynecology, Obstetrics II, and Reproductive Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department of Development, Reproduction, and Cancer, Cochin Institute, INSERM U1016, Paris, France
| | - M Sorel
- Department of Gynecology, Obstetrics II, and Reproductive Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
| | - C Maignien
- Department of Gynecology, Obstetrics II, and Reproductive Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
| | - J Guibourdenche
- Faculté de Santé, University of Paris Cité, Paris, France
- Department of Biological Endocrinology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
| | - C Patrat
- Faculté de Santé, University of Paris Cité, Paris, France
- Department of Histology and Reproductive Biology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
| | - L Marcellin
- Faculté de Santé, University of Paris Cité, Paris, France
- Department of Gynecology, Obstetrics II, and Reproductive Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department of Development, Reproduction, and Cancer, Cochin Institute, INSERM U1016, Paris, France
| | - T Jobin
- Department of Gynecology, Obstetrics II, and Reproductive Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
| | - C Chapron
- Faculté de Santé, University of Paris Cité, Paris, France
- Department of Gynecology, Obstetrics II, and Reproductive Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department of Development, Reproduction, and Cancer, Cochin Institute, INSERM U1016, Paris, France
| | - P Santulli
- Faculté de Santé, University of Paris Cité, Paris, France
- Department of Gynecology, Obstetrics II, and Reproductive Medicine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department of Development, Reproduction, and Cancer, Cochin Institute, INSERM U1016, Paris, France
| |
Collapse
|
3
|
Chapron C, Marcellin L, Maitrot-Mantelet L, Bourdon M, Maignien C, Parpex G, Santulli P. Questionnaire-based screening of adolescents and young adult women can identify markers associated with endometriosis. Hum Reprod 2024; 39:1664-1672. [PMID: 38901867 DOI: 10.1093/humrep/deae125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 05/04/2024] [Indexed: 06/22/2024] Open
Abstract
STUDY QUESTION Do adolescents and young adult women (YAW) with histologically proven endometriosis present a specific clinical history? SUMMARY ANSWER Questionnaire screening of adolescents and YAW can identify clinical markers associated with histologically proven endometriosis. WHAT IS KNOWN ALREADY Some validated questionaries can contribute to an earlier endometriosis diagnosis in adults. None of these scores, however, have been validated for adolescents or YAW. STUDY DESIGN, SIZE, DURATION This was an observational cross-sectional study using prospectively recorded data performed between January 2005 and January 2020 in a single university tertiary referral centre for endometriosis diagnosis and management. After a thorough surgical examination of the abdomino-pelvic cavity, women with histologically proven endometriosis were allocated to the endometriosis group, and symptomatic women without evidence of endometriosis were allocated to the endometriosis-free control group. The endometriotic patients were allocated into two sub-groups according to their age: adolescent (≤20 years) and YAW (21-24 years). PARTICIPANTS/MATERIALS, SETTING, METHODS Adolescents and YAW ≤24 years of age were operated for a symptomatic benign gynaecological condition with signed informed consent. A standardized questionnaire was prospectively completed in the month before the surgery and included epidemiological data, pelvic pain scores, family history of endometriosis, and symptoms experienced during adolescence. The study searched for correlations by univariate analysis to determine clinical markers of endometriosis in adolescents and YAW compared with endometriosis-free control patients. MAIN RESULTS AND THE ROLE OF CHANCE Of the 262 study participants, 77 women were adolescents (≤20 years of age) and 185 patients (70.6%) were YAW. The endometriosis group included 118 patients (45.0%) and 144 (55.0%) were assigned to the control group. A family history of endometriosis, absenteeism from school during menstruation, history of fainting spells during menstruation, and prescription of oral contraceptive pills for intense dysmenorrhea were significantly more frequently observed in the endometriotic patients. The prevalence and mean pain scores for dysmenorrhea, deep dyspareunia, non-cyclic chronic pelvic pain and gastrointestinal and lower urinary tract symptoms were significantly greater in the endometriosis group, as was experienced rectal bleeding. LIMITATIONS, REASONS FOR CAUTION The study was performed in a single referral centre that treats patients with potentially more severe disease. This questionnaire was evaluated on a population of patients with an indication for endometriosis surgery, which can also select patients with more severe disease. Women with asymptomatic endometriosis were not considered in this study. These factors can affect the external validity of this study. WIDER IMPLICATIONS OF THE FINDINGS Patient interviews are relevant to the diagnosis of endometriosis in adolescents and YAW. Combined with imaging and clinical examination, this approach will enable earlier diagnosis and treatment, while remaining non-invasive and rapid. STUDY FUNDING/COMPETING INTEREST(S) The study received no funding from external sources. There are no conflicts of interest. TRIAL REGISTRATION NUMBER N/A.
Collapse
Affiliation(s)
- Charles Chapron
- Faculté de Santé, Faculté de Médicine Paris Centre, Université Paris-Cité, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department of Gynecology Obstetrics II and Reproductive Medicine, Paris, France
- Department "Development, Reproduction and Cancer", Institut Cochin, INSERM U1016, Paris, France
| | - Louis Marcellin
- Faculté de Santé, Faculté de Médicine Paris Centre, Université Paris-Cité, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department of Gynecology Obstetrics II and Reproductive Medicine, Paris, France
- Department "Development, Reproduction and Cancer", Institut Cochin, INSERM U1016, Paris, France
| | - Lorraine Maitrot-Mantelet
- Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department of Gynecology Obstetrics II and Reproductive Medicine, Paris, France
| | - Mathilde Bourdon
- Faculté de Santé, Faculté de Médicine Paris Centre, Université Paris-Cité, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department of Gynecology Obstetrics II and Reproductive Medicine, Paris, France
- Department "Development, Reproduction and Cancer", Institut Cochin, INSERM U1016, Paris, France
| | - Chloé Maignien
- Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department of Gynecology Obstetrics II and Reproductive Medicine, Paris, France
| | - Guillaume Parpex
- Faculté de Santé, Faculté de Médicine Paris Centre, Université Paris-Cité, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department of Gynecology Obstetrics II and Reproductive Medicine, Paris, France
- Department "Development, Reproduction and Cancer", Institut Cochin, INSERM U1016, Paris, France
| | - Pietro Santulli
- Faculté de Santé, Faculté de Médicine Paris Centre, Université Paris-Cité, Paris, France
- Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department of Gynecology Obstetrics II and Reproductive Medicine, Paris, France
- Department "Development, Reproduction and Cancer", Institut Cochin, INSERM U1016, Paris, France
| |
Collapse
|
4
|
Ruaux E, Nougaret S, Gavrel M, Charlot M, Devouassoux-Shisheboran M, Golfier F, Thomassin-Naggara I, Rousset P. Endometriosis MR mimickers: T1-hyperintense lesions. Insights Imaging 2024; 15:19. [PMID: 38267748 PMCID: PMC10808095 DOI: 10.1186/s13244-023-01587-3] [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: 06/27/2023] [Accepted: 11/25/2023] [Indexed: 01/26/2024] Open
Abstract
Endometriosis is a chronic and disabling gynecological disease that affects women of reproductive age. Magnetic resonance imaging (MRI) is considered the cornerstone radiological technique for both the diagnosis and management of endometriosis. While MRI offers higher sensitivity compared to ultrasonography, it is prone to false-positive results, leading to decreased specificity. False-positive findings can arise from various T1-hyperintense conditions on fat-suppressed T1-weighted images, resembling endometriotic cystic lesions in different anatomical compartments. These conditions include hemorrhage, hyperproteic content, MRI artifacts, feces, or melanin. Such false positives can have significant implications for patient care, ranging from incorrect diagnoses to unnecessary medical or surgical interventions and subsequent follow-up. To address these challenges, this educational review aims to provide radiologists with comprehensive knowledge about MRI criteria, potential pitfalls, and differential diagnoses, ultimately reducing false-positive results related to T1-hyperintense abnormalities.Critical relevance statementMRI has a 10% false-positive rate, leading to misdiagnosis. T1-hyperintense lesions, observed in the three phenotypes of pelvic endometriosis, can also be seen in various other causes, mainly caused by hemorrhages, high protein concentrations, and artifacts.Key points• MRI in endometriosis has a 10% false-positive rate, leading to potential misdiagnosis.• Pelvic endometriosis lesions can exhibit T1-hyperintensity across their three phenotypes.• A definitive diagnosis of a T1-hyperintense endometriotic lesion is crucial for patient management.• Hemorrhages, high protein concentrations, lipids, and artifacts are the main sources of T1-hyperintense mimickers.
Collapse
Affiliation(s)
- Edouard Ruaux
- Department of Radiology, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon 1 Claude Bernard University, 165 Chemin du Grand Revoyet, EMR 3738, 69495, Pierre Bénite, France
| | - Stéphanie Nougaret
- Department of Radiology, Montpellier Cancer Institute, U1194, Montpellier University, 34295, Montpellier, France
| | - Marie Gavrel
- Department of Radiology, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon 1 Claude Bernard University, EMR 3738, Pierre Bénite, France
| | - Mathilde Charlot
- Department of Radiology, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon 1 Claude Bernard University, EMR 3738, Pierre Bénite, France
| | - Mojgan Devouassoux-Shisheboran
- Department of Pathology, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon 1 Claude Bernard University, 69495, Pierre Bénite, France
| | - François Golfier
- Department of Gynecology and Obstetrics, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon 1 Claude Bernard University, EMR 3738, 69495, Pierre Bénite, France
| | - Isabelle Thomassin-Naggara
- Department of Radiology, Service Imageries Radiologiques et Interventionnelles Spécialisées, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Sorbonne Université, 75020, Paris, France
| | - Pascal Rousset
- Department of Radiology, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon 1 Claude Bernard University, 165 Chemin du Grand Revoyet, EMR 3738, 69495, Pierre Bénite, France.
| |
Collapse
|
5
|
Radzynski L, Boyer L, Kossai M, Mouraire A, Montoriol PF. Pictorial essay: MRI evaluation of endometriosis-associated neoplasms. Insights Imaging 2023; 14:144. [PMID: 37673827 PMCID: PMC10482819 DOI: 10.1186/s13244-023-01485-8] [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: 02/09/2023] [Accepted: 07/08/2023] [Indexed: 09/08/2023] Open
Abstract
Endometriosis is a frequent pathology mostly affecting women of young age. When typical aspects are present, the diagnosis can easily be made at imaging, especially at MRI. Transformation of benign endometriosis to endometriosis-associated neoplasms is rare. The physiopathology is complex and remains controversial. Endometrioid carcinoma and clear cell carcinoma are the main histological subtypes. Our goal was to review the main imaging characteristics that should point to an ovarian or extra-ovarian endometriosis-related tumor, especially at MRI, as it may be relevant prior to surgical management.Key points• Transformation of benign endometriosis to endometriosis-associated neoplasms is rare.• MRI is useful when displaying endometriosis lesions associated to an ovarian tumor.• Subtraction imaging should be used in the evaluation of complex endometriomas.
Collapse
Affiliation(s)
- Louise Radzynski
- Department of Radiology, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.
| | - Louis Boyer
- Department of Radiology, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Myriam Kossai
- Department of Pathology, Cancer Center of Clermont-Ferrand, Clermont-Ferrand, France
| | - Anne Mouraire
- Department of Pathology, Cancer Center of Clermont-Ferrand, Clermont-Ferrand, France
| | | |
Collapse
|
6
|
Li T. Pancreatic cavernous hemangioma complicated with chronic intracapsular spontaneous hemorrhage: A case report and review of literature. World J Clin Cases 2023; 11:5615-5621. [PMID: 37637682 PMCID: PMC10450382 DOI: 10.12998/wjcc.v11.i23.5615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/11/2023] [Accepted: 07/25/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Pancreatic cavernous hemangioma (pCH) is a rare type of benign vascular tumor. Making the right diagnosis is challenging due to low clinical suspicion and the lack of existing cross-sectional imaging tools to distinguish it from other pancreatic lesions. CASE SUMMARY We describe a male patient, age 18, who presented with a pCH. Computed tomography, magnetic resonance imaging, and ultrasound showed cystic space in the tail of the pancreas. A dark spot sign on the T2 weighted image sequence was observed. Clinically, a mucinous cystic neoplasm with hemorrhage was suspected preoperatively by combining imaging, and the operative indication was clear. The patient underwent a distal pancreatic tumor resection under laparoscopic control. Immunohistochemical staining for CD31 and CD34 was positive; D2-40 was positive in interstitial lymphatic vessels and negative in vascular epithelial cells; and calcium-binding protein was negative. The results support the diagnosis of pCH combined with chronic intracapsular spontaneous hemorrhage. No complications or recurrences were observed during the follow-up period. CONCLUSION Chronic spontaneous hemorrhage may occur in pCH, which may greatly influence the accuracy of diagnosis using imaging modalities. Surgical resection for uncertain pCH seems reasonable with a good outcome.
Collapse
Affiliation(s)
- Ting Li
- Department of Radiology, Yongkang First People’s Hospital, Yongkang 321300, Zhejiang Province, China
| |
Collapse
|
7
|
AlNuaimi D, Akmal Y, AlDuaij A, Sherif A, Abdulghaffar S, Cem Balci N. Pancreatic endometrioma : a rare differential diagnosis for a pseudocyst. BJR Case Rep 2023; 9:20220141. [PMID: 36873241 PMCID: PMC9976728 DOI: 10.1259/bjrcr.20220141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/22/2022] [Accepted: 11/27/2022] [Indexed: 12/13/2022] Open
Abstract
Pancreatic endometriosis is extremely rare with only 14 cases reported in the medical literature and its diagnosis on radiological imaging poses a great challenge. We report a case of a 31-year-old female patient with recurrent admissions for pancreatitis of unknown aetiology and no relevant previous medical history. Sectional imaging showed a cystic lesion in the tail of the pancreas and the diagnosis of a post-pancreatitis pseudocyst or a less likely pre-malignant mucinous cystadenoma was considered. On post-robotic resection of the pancreatic cyst, the histopathology analysis was positive for endometrial stroma. Pancreatic endometriosis although rare should be considered as a differential diagnosis for cystic lesions especially in patients who are known to have pelvic endometriosis. Nevertheless, the gold standard for the definite diagnosis of pancreatic endometriosis remains histopathological.
Collapse
Affiliation(s)
- Dana AlNuaimi
- Fatima College of Health Sciences, Radiology and Medical Imaging Department, Abu Dhabi, United Arab Emirates
| | | | | | - Ahmed Sherif
- Cleveland Clinic Abu Dhabi, AlMaryah Island, Abu Dhabi, United Arab Emirates
| | | | | |
Collapse
|
8
|
Li Y, Lu X, Chen L, Zhang Q, Wang N, Wang J, Lin L, Hu G, Zhang Y, Liu A. Identification of ovarian endometriotic cysts in cystic lesions of the ovary by amide proton transfer-weighted imaging and R2∗ mapping. Clin Radiol 2023; 78:e106-e112. [PMID: 36334944 DOI: 10.1016/j.crad.2022.09.117] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 09/07/2022] [Accepted: 09/13/2022] [Indexed: 11/06/2022]
Abstract
AIM To investigate the value of amide proton transfer weighted (APTw) imaging and R2∗ mapping of cystic fluid in differentiating ovarian endometriotic cysts (OE) from other ovarian cystic (OOC) lesions. MATERIALS AND METHODS A total of 42 patients who underwent 3 T pelvic magnetic resonance imaging (MRI) were enrolled. Nineteen lesions were OE and 27 lesions were OOC. The APTw imaging and R2∗ values of the cystic fluid were measured and compared between the two groups using the independent sample t-test or Mann-Whitney U-test. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic efficacy of different parameters. The area under ROC curves (AUCs) was compared using the Delong test. Spearman's correlation analysis was used to assess the correlation between APTw imaging and R2∗ values. RESULTS APTw imaging values of OE were lower, while R2∗ values were higher in OE than those in OOC (p=0.001 and < 0.001). The AUCs of APTw imaging and R2∗ values to identify OE from OOC were 0.910 and 0.975. The AUC increased to 0.990 when combining APTw imaging and R2∗ values, yet without a significant difference to the APTw imaging or R2∗ value alone (p=0.229 and 0.082, respectively). APTw imaging values were negatively correlated with R2∗ values (r=-0.522, p<0.001). CONCLUSION Both APTw imaging and R2∗ values of OE are significantly different from other ovarian cystic lesions. APTw imaging combined with R2∗ values show excellent diagnostic efficacy to differentiate between OE and OOC.
Collapse
Affiliation(s)
- Y Li
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - X Lu
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - L Chen
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Q Zhang
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - N Wang
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - J Wang
- Philips Healthcare, Beijing, China
| | - L Lin
- Philips Healthcare, Beijing, China
| | - G Hu
- Philips Healthcare, Beijing, China
| | - Y Zhang
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, Zhejiang, China
| | - A Liu
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.
| |
Collapse
|
9
|
Pausch AM, Donati OF, Hötker AM. Bilateral Ovarian Endometriomas: A Case Report. Top Magn Reson Imaging 2022; 31:51-52. [PMID: 36378902 PMCID: PMC9750095 DOI: 10.1097/rmr.0000000000000300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/12/2022] [Accepted: 09/16/2022] [Indexed: 06/16/2023]
Affiliation(s)
- Antonia M. Pausch
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Olivio F. Donati
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Andreas M. Hötker
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
10
|
Advances in Imaging for Assessing Pelvic Endometriosis. Diagnostics (Basel) 2022; 12:diagnostics12122960. [PMID: 36552967 PMCID: PMC9777476 DOI: 10.3390/diagnostics12122960] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022] Open
Abstract
In recent years, due to the development of standardized diagnostic protocols associated with an improvement in the associated technology, the diagnosis of pelvic endometriosis using imaging is becoming a reality. In particular, transvaginal ultrasound and magnetic resonance are today the two imaging techniques that can accurately identify the majority of the phenotypes of endometriosis. This review focuses not only on these most common imaging modalities but also on some additional radiological techniques that were proposed for rectosigmoid colon endometriosis, such as double-contrast barium enema, rectal endoscopic ultrasonography, multidetector computed tomography enema, computed tomography colonography and positron emission tomography-computed tomography with 16α-[18F]fluoro-17β-estradiol.
Collapse
|
11
|
Sakala MD, Jha P, Tong A, Taffel MT, Feldman MK. MR Imaging of Endometriosis of the Adnexa. Magn Reson Imaging Clin N Am 2022; 31:121-135. [DOI: 10.1016/j.mric.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
12
|
Gopireddy DR, Virarkar M, Kumar S, Vulasala SSR, Nwachukwu C, Lamsal S. Acute pelvic pain: A pictorial review with magnetic resonance imaging. J Clin Imaging Sci 2022; 12:48. [PMID: 36128358 PMCID: PMC9479569 DOI: 10.25259/jcis_70_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 07/22/2022] [Indexed: 11/04/2022] Open
Abstract
Acute uterine emergencies constitute both obstetric and gynecologic conditions. The superior image resolution, superior soft-tissue characterization, and lack of ionizing radiation make magnetic resonance imaging (MRI) preferable over ultrasonography (USG) and computed tomography (CT) in investigating uterine emergencies. Although USG is the first-line imaging modality and is easily accessible, it has limitations. USG is an operator dependent and limited by patient factors such as obesity and muscle atrophy. CT is limited by its risk of teratogenicity in pregnant females, poor tissue differentiation, and radiation effect. The non-specific findings on CT may lead to misinterpretation of the pathology. MRI overcomes all these limitations and is emerging as the most crucial imaging modality in the emergency room (ER). The evolving 3D MR sequences further reduce the acquisition times, expanding its ER role. Although MRI is not the first-line imaging modality, it is a problem-solving tool when the ultrasound and CT are inconclusive. This pictorial review discusses the various MRI techniques used in uterine imaging and the appearances of distinct etiologies of uterine emergencies across different MRI sequences.
Collapse
Affiliation(s)
- Dheeraj Reddy Gopireddy
- Department of Radiology, UF College of Medicine-Jacksonville, Jacksonville, Florida, United States,
| | - Mayur Virarkar
- Department of Radiology, UF College of Medicine-Jacksonville, Jacksonville, Florida, United States,
| | - Sindhu Kumar
- Department of Radiology, UF College of Medicine-Jacksonville, Jacksonville, Florida, United States,
| | | | - Chidi Nwachukwu
- Department of Radiology, UF College of Medicine-Jacksonville, Jacksonville, Florida, United States,
| | - Sanjay Lamsal
- Department of Radiology, UF College of Medicine-Jacksonville, Jacksonville, Florida, United States,
| |
Collapse
|
13
|
Sorrentino F, DE Padova M, Falagario M, D'Alteri O MN, DI Spiezio Sardo A, Pacheco LA, Carugno JT, Nappi L. Endometriosis and adverse pregnancy outcome. Minerva Obstet Gynecol 2022; 74:31-44. [PMID: 34096691 DOI: 10.23736/s2724-606x.20.04718-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Endometriosis is a gynecologic disease affecting approximately 10% of reproductive age women, around 21-47% of women presenting subfertility and 71-87% of women with chronic pelvic pain. Main symptoms are chronic pelvic pain, dysmenorrhea, dyspareunia and infertility that seem to be well controlled by oral contraceptive pill, progestogens, GnRh antagonists. The aim of this review was to illustrate the modern diagnosis of endometriosis during pregnancy, to evaluate the evolution of endometriotic lesions during pregnancy and the incidence of adverse outcomes. EVIDENCE ACQUISITION Published literature was retrieved through searches of the database PubMed (National Center for Biotechnology Information, US National Library of Medicine, Bethesda, MD, USA). We searched for all original articles published in English through April 2020 and decided to extract every notable information for potential inclusion in this review. The search included the following MeSH search terms, alone or in combination: "endometriosis" combined with "endometrioma," "biomarkers," "complications," "bowel," "urinary tract," "uterine rupture," "spontaneous hemoperitoneum in pregnancy" and more "adverse pregnancy outcome," "preterm birth," "miscarriage," "abruption placentae," "placenta previa," "hypertensive disorder," "preeclampsia," "fetal grow restriction," "small for gestation age," "cesarean delivery." EVIDENCE SYNTHESIS Pregnancy in women with endometriosis does not always lead to disappearance of symptoms and decrease in the size of endometriotic lesions, but it may be possible to observe a malignant transformation of ovarian endometriotic lesions. Onset of complications may be caused by many factors: chronic inflammation, adhesions, progesterone resistance and a dysregulation of genes involved in the embryo implantation. As results, the pregnancy can be more difficult because of endometriosis related complications (spontaneous hemoperitoneum [SH], bowel complications, etc.) or adverse outcomes like preterm birth, FGR, hypertensive disorders, obstetrics hemorrhages (placenta previa, abruptio placenta), miscarriage or cesarean section. Due to insufficient knowledge about its pathogenesis, currently literature data are contradictory and do not show a strong correlation between endometriosis and these complications except for miscarriage and cesarean delivery. CONCLUSIONS Future research should focus on the potential biological pathways underlying these relationships in order to inform patients planning a birth about possible complications during pregnancy.
Collapse
Affiliation(s)
- Felice Sorrentino
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, Foggia, Italy
| | - Maristella DE Padova
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, Foggia, Italy
| | - Maddalena Falagario
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, Foggia, Italy
| | - Maurizio N D'Alteri O
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
| | - Attilio DI Spiezio Sardo
- School of Medicine, Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Luis A Pacheco
- Unit of Gynecologic Endoscopy, Gutenberg Center, Xanit International Hospital, Málaga, Spain
| | - Jose T Carugno
- Miller School of Medicine, Department of Obstetrics and Gynecology, University of Miami, Miami, FL, USA
| | - Luigi Nappi
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, Foggia, Italy -
| |
Collapse
|
14
|
Sadowski EA, Thomassin-Naggara I, Rockall A, Maturen KE, Forstner R, Jha P, Nougaret S, Siegelman ES, Reinhold C. O-RADS MRI Risk Stratification System: Guide for Assessing Adnexal Lesions from the ACR O-RADS Committee. Radiology 2022; 303:35-47. [PMID: 35040672 PMCID: PMC8962917 DOI: 10.1148/radiol.204371] [Citation(s) in RCA: 61] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
MRI plays an important role as a secondary test or problem-solving modality in the evaluation of adnexal lesions depicted at US. MRI has increased specificity compared with US, decreasing the number of false-positive diagnoses for malignancy and thereby avoiding unnecessary or over-extensive surgery in patients with benign lesions or borderline tumors, while women with possible malignancies can be expeditiously referred for oncologic surgical evaluation. The Ovarian-Adnexal Reporting and Data System (O-RADS) MRI Committee is an international collaborative effort formed under the direction of the American College of Radiology and includes a diverse group of experts on adnexal imaging and management who developed the O-RADS MRI risk stratification system. This scoring system assigns a probability of malignancy based on the MRI features of an adnexal lesion and provides information to facilitate optimal patient management. The widespread implementation of a codified reporting system will lead to improved interpretation agreement and standardized communication between radiologists and referring physicians. In addition, it will allow for high-quality multi-institutional collaborations-an important unmet need that has hampered the performance of high-quality research in this area in the past. This article provides guidelines on using the O-RADS MRI risk stratification system in clinical practice, as well as in the educational and research settings.
Collapse
Affiliation(s)
- Elizabeth A Sadowski
- From the Departments of Radiology and Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372 Madison, WI 53792-3252 (E.A.S.); Service d'Imageries Radiologiques et Interventionnelles Spécialisées (IRIS), Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France (I.T.N.); Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, England (A.R.); Departments of Radiology and Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Universitätsklinikum Salzburg, PMU Salzburg, Salzburg, Austria (R.F.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (P.J.); Department of Radiology, IRCM INSERM, U1194 SIRIC, Montpellier, France (S.N.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (E.S.S.); Department of Radiology, McGill University Health Centre, McGill University, Montreal, Canada (C.R.); and Augmented Intelligence & Precision Health Laboratory, Research Institute of McGill University Health Centre, Montreal, Canada (C.R.)
| | - Isabelle Thomassin-Naggara
- From the Departments of Radiology and Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372 Madison, WI 53792-3252 (E.A.S.); Service d'Imageries Radiologiques et Interventionnelles Spécialisées (IRIS), Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France (I.T.N.); Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, England (A.R.); Departments of Radiology and Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Universitätsklinikum Salzburg, PMU Salzburg, Salzburg, Austria (R.F.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (P.J.); Department of Radiology, IRCM INSERM, U1194 SIRIC, Montpellier, France (S.N.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (E.S.S.); Department of Radiology, McGill University Health Centre, McGill University, Montreal, Canada (C.R.); and Augmented Intelligence & Precision Health Laboratory, Research Institute of McGill University Health Centre, Montreal, Canada (C.R.)
| | - Andrea Rockall
- From the Departments of Radiology and Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372 Madison, WI 53792-3252 (E.A.S.); Service d'Imageries Radiologiques et Interventionnelles Spécialisées (IRIS), Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France (I.T.N.); Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, England (A.R.); Departments of Radiology and Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Universitätsklinikum Salzburg, PMU Salzburg, Salzburg, Austria (R.F.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (P.J.); Department of Radiology, IRCM INSERM, U1194 SIRIC, Montpellier, France (S.N.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (E.S.S.); Department of Radiology, McGill University Health Centre, McGill University, Montreal, Canada (C.R.); and Augmented Intelligence & Precision Health Laboratory, Research Institute of McGill University Health Centre, Montreal, Canada (C.R.)
| | - Katherine E Maturen
- From the Departments of Radiology and Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372 Madison, WI 53792-3252 (E.A.S.); Service d'Imageries Radiologiques et Interventionnelles Spécialisées (IRIS), Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France (I.T.N.); Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, England (A.R.); Departments of Radiology and Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Universitätsklinikum Salzburg, PMU Salzburg, Salzburg, Austria (R.F.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (P.J.); Department of Radiology, IRCM INSERM, U1194 SIRIC, Montpellier, France (S.N.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (E.S.S.); Department of Radiology, McGill University Health Centre, McGill University, Montreal, Canada (C.R.); and Augmented Intelligence & Precision Health Laboratory, Research Institute of McGill University Health Centre, Montreal, Canada (C.R.)
| | - Rosemarie Forstner
- From the Departments of Radiology and Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372 Madison, WI 53792-3252 (E.A.S.); Service d'Imageries Radiologiques et Interventionnelles Spécialisées (IRIS), Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France (I.T.N.); Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, England (A.R.); Departments of Radiology and Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Universitätsklinikum Salzburg, PMU Salzburg, Salzburg, Austria (R.F.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (P.J.); Department of Radiology, IRCM INSERM, U1194 SIRIC, Montpellier, France (S.N.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (E.S.S.); Department of Radiology, McGill University Health Centre, McGill University, Montreal, Canada (C.R.); and Augmented Intelligence & Precision Health Laboratory, Research Institute of McGill University Health Centre, Montreal, Canada (C.R.)
| | - Priyanka Jha
- From the Departments of Radiology and Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372 Madison, WI 53792-3252 (E.A.S.); Service d'Imageries Radiologiques et Interventionnelles Spécialisées (IRIS), Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France (I.T.N.); Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, England (A.R.); Departments of Radiology and Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Universitätsklinikum Salzburg, PMU Salzburg, Salzburg, Austria (R.F.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (P.J.); Department of Radiology, IRCM INSERM, U1194 SIRIC, Montpellier, France (S.N.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (E.S.S.); Department of Radiology, McGill University Health Centre, McGill University, Montreal, Canada (C.R.); and Augmented Intelligence & Precision Health Laboratory, Research Institute of McGill University Health Centre, Montreal, Canada (C.R.)
| | - Stephanie Nougaret
- From the Departments of Radiology and Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372 Madison, WI 53792-3252 (E.A.S.); Service d'Imageries Radiologiques et Interventionnelles Spécialisées (IRIS), Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France (I.T.N.); Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, England (A.R.); Departments of Radiology and Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Universitätsklinikum Salzburg, PMU Salzburg, Salzburg, Austria (R.F.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (P.J.); Department of Radiology, IRCM INSERM, U1194 SIRIC, Montpellier, France (S.N.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (E.S.S.); Department of Radiology, McGill University Health Centre, McGill University, Montreal, Canada (C.R.); and Augmented Intelligence & Precision Health Laboratory, Research Institute of McGill University Health Centre, Montreal, Canada (C.R.)
| | - Evan S Siegelman
- From the Departments of Radiology and Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372 Madison, WI 53792-3252 (E.A.S.); Service d'Imageries Radiologiques et Interventionnelles Spécialisées (IRIS), Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France (I.T.N.); Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, England (A.R.); Departments of Radiology and Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Universitätsklinikum Salzburg, PMU Salzburg, Salzburg, Austria (R.F.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (P.J.); Department of Radiology, IRCM INSERM, U1194 SIRIC, Montpellier, France (S.N.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (E.S.S.); Department of Radiology, McGill University Health Centre, McGill University, Montreal, Canada (C.R.); and Augmented Intelligence & Precision Health Laboratory, Research Institute of McGill University Health Centre, Montreal, Canada (C.R.)
| | - Caroline Reinhold
- From the Departments of Radiology and Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, E3/372 Madison, WI 53792-3252 (E.A.S.); Service d'Imageries Radiologiques et Interventionnelles Spécialisées (IRIS), Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France (I.T.N.); Division of Surgery and Cancer, Imperial College London, Hammersmith Campus, London, England (A.R.); Departments of Radiology and Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich (K.E.M.); Department of Radiology, Universitätsklinikum Salzburg, PMU Salzburg, Salzburg, Austria (R.F.); Department of Radiology, University of California-San Francisco, San Francisco, Calif (P.J.); Department of Radiology, IRCM INSERM, U1194 SIRIC, Montpellier, France (S.N.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (E.S.S.); Department of Radiology, McGill University Health Centre, McGill University, Montreal, Canada (C.R.); and Augmented Intelligence & Precision Health Laboratory, Research Institute of McGill University Health Centre, Montreal, Canada (C.R.)
| |
Collapse
|
15
|
Kido A, Himoto Y, Moribata Y, Kurata Y, Nakamoto Y. MRI in the Diagnosis of Endometriosis and Related Diseases. Korean J Radiol 2022; 23:426-445. [PMID: 35289148 PMCID: PMC8961012 DOI: 10.3348/kjr.2021.0405] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 10/15/2021] [Accepted: 11/11/2021] [Indexed: 11/15/2022] Open
Abstract
Endometriosis, a common chronic inflammatory disease in female of reproductive age, is closely related to patient symptoms and fertility. Because of its high contrast resolution and objectivity, MRI can contribute to the early and accurate diagnosis of ovarian endometriotic cysts and deeply infiltrating endometriosis without the need for any invasive procedure or radiation exposure. The ovaries, which are the most frequent site of endometriosis, can be afflicted by multiple related conditions and diseases. For the diagnosis of deeply infiltrating endometriosis and secondary adhesions among pelvic organs, fibrosis around the ectopic endometrial gland is usually found as a T2 hypointense lesion. This review summarizes the MRI findings obtained for ovarian endometriotic cysts and their physiologically and pathologically related conditions. This article also includes the key imaging findings of deeply infiltrating endometriosis.
Collapse
Affiliation(s)
- Aki Kido
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Hospital, Kyoto, Japan
| | - Yuki Himoto
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Hospital, Kyoto, Japan
| | - Yusaku Moribata
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Hospital, Kyoto, Japan
| | - Yasuhisa Kurata
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Hospital, Kyoto, Japan
| | - Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Hospital, Kyoto, Japan
| |
Collapse
|
16
|
OUP accepted manuscript. Hum Reprod 2022; 37:1470-1479. [DOI: 10.1093/humrep/deac083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 04/05/2022] [Indexed: 11/13/2022] Open
|
17
|
Lorusso F, Scioscia M, Rubini D, Stabile Ianora AA, Scardigno D, Leuci C, De Ceglie M, Sardaro A, Lucarelli N, Scardapane A. Magnetic resonance imaging for deep infiltrating endometriosis: current concepts, imaging technique and key findings. Insights Imaging 2021; 12:105. [PMID: 34292422 PMCID: PMC8298718 DOI: 10.1186/s13244-021-01054-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 07/05/2021] [Indexed: 12/24/2022] Open
Abstract
Endometriosis is an estrogen-dependent chronic disease affecting about 10% of reproductive-age women with symptoms like pelvic pain and infertility. Pathologically, it is defined by the presence of endometrial tissue outside the uterine cavity responsible for a chronic inflammatory process. For decades the diagnosis of endometriosis was based on surgical exploration and biopsy of pelvic lesions. However, laparoscopy is not a risk-free procedure with possible false negative diagnosis due to an underestimate of retroperitoneal structures such as ureters and nerves. For these reasons nowadays, the diagnosis of endometriosis is based on a noninvasive approach where clinical history, response to therapy and imaging play a fundamental role. Trans-vaginal ultrasound and magnetic resonance imaging are suitable for recognizing most of endometriotic lesions; nevertheless, their accuracy is strictly determined by operators’ experience and imaging technique. This review paper aims to make radiologists aware of the diagnostic possibilities of pelvic MRI and familial with the MR acquisition protocols and image interpretation for women with endometriosis.
Collapse
Affiliation(s)
- Filomenamila Lorusso
- University of Bari Medical School - Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, Piazza Giulio Cesare, 11, 70124, Bari, Italy
| | | | - Dino Rubini
- University of Bari Medical School - Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, Piazza Giulio Cesare, 11, 70124, Bari, Italy
| | - Amato Antonio Stabile Ianora
- University of Bari Medical School - Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, Piazza Giulio Cesare, 11, 70124, Bari, Italy
| | | | - Carla Leuci
- University of Bari Medical School - Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, Piazza Giulio Cesare, 11, 70124, Bari, Italy
| | - Michele De Ceglie
- University of Bari Medical School - Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, Piazza Giulio Cesare, 11, 70124, Bari, Italy
| | - Angela Sardaro
- University of Bari Medical School - Interdisciplinary Department of Medicine, Section of Radiation Therapy, Bari, Italy
| | - Nicola Lucarelli
- University of Bari Medical School - Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, Piazza Giulio Cesare, 11, 70124, Bari, Italy
| | - Arnaldo Scardapane
- University of Bari Medical School - Interdisciplinary Department of Medicine, Section of Diagnostic Imaging, Piazza Giulio Cesare, 11, 70124, Bari, Italy.
| |
Collapse
|
18
|
Lupean RA, Ștefan PA, Lebovici A, Csutak C, Rusu GM, Mihu CM. Differentiation of Endometriomas from Hemorrhagic Cysts at Magnetic Resonance: The Role of Quantitative Signal Intensity Measurements. Curr Med Imaging 2021; 17:524-531. [PMID: 33115394 DOI: 10.2174/1573405616999201027211132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/26/2020] [Accepted: 08/12/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Endometriomas and functional hemorrhagic cysts (FHCs) are a common gynecological encounter. OBJECTIVE This study aimed to assess the diagnostic efficiency of magnetic resonance imaging (MRI) using signal intensity measurements in differentiating endometriomas from FHCs. METHODS Forty-six patients who underwent pelvic MRI examinations (endometriomas, n=28; FHCs, n=18) were retrospectively included. The "T2 shading" sign was evaluated subjectively and quantitatively by measuring the T1-T2 signal intensity difference and calculating the percentage of signal decrease between T1 and T2-weighted sequences. The resulted values, along with the measurement of the Apparent Diffusion Coefficient (ADC) and the signal intensity on three diffusion- weighted sequences (DWI) (b50, b400, and b800), were compared between groups by using the Mann-Whitney U test. Also, the receiver operating characteristic analysis was performed for the statistically significant results (P<0.016), and the area under the curve (AUC) was also calculated. RESULTS The two quantitative assessment methods showed similar efficiency in detecting endometriomas (P<0.001; sensitivity, 100%; specificity, 81.82%; AUC>0.86), outperforming the classic subjective evaluation of the "T2 shading" sign (sensitivity, 92.86%; specificity, 66.67%). ADC (P=0.52) and DWI measurements (P=0.49, P=0.74, and P=0.78) failed to distinguish between the two entities. CONCLUSION The quantitative analysis and interpretation of the "T2 shading" sign can significantly improve the differential diagnosis between endometriomas and FHCs.
Collapse
Affiliation(s)
- Roxana-Adelina Lupean
- Histology, Morphological Sciences Department, "Iuliu Hațieganu" University of Medicine and Pharmacy; Louis Pasteur street, number 4, Cluj-Napoca, 400349, Cluj, Romania
| | - Paul-Andrei Ștefan
- Radiology and Imaging Department, County Emergency Hospital, Cluj-Napoca; Clinicilor street, number 3-5, Cluj-Napoca, 400006, Cluj, Romania
| | - Andrei Lebovici
- Radiology and Imaging Department, County Emergency Hospital, Cluj-Napoca; Clinicilor street, number 3-5, Cluj-Napoca, 400006, Cluj, Romania
| | - Csaba Csutak
- Radiology and Imaging Department, County Emergency Hospital, Cluj-Napoca; Clinicilor street, number 3-5, Cluj-Napoca, 400006, Cluj, Romania
| | - Georgeta Mihaela Rusu
- Radiology and Imaging Department, County Emergency Hospital, Cluj-Napoca; Clinicilor street, number 3-5, Cluj-Napoca, 400006, Cluj, Romania
| | - Carmen Mihaela Mihu
- Radiology and Imaging Department, County Emergency Hospital, Cluj-Napoca; Clinicilor street, number 3-5, Cluj-Napoca, 400006, Cluj, Romania
| |
Collapse
|
19
|
Celli V, Ciulla S, Dolciami M, Satta S, Ercolani G, Porpora MG, Catalano C, Manganaro L. Magnetic Resonance Imaging in endometriosis-associated pain. Minerva Obstet Gynecol 2021; 73:553-571. [PMID: 33904689 DOI: 10.23736/s2724-606x.21.04782-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Endometriosis affects 10%-15% of women in reproductive age and may cause no-cyclic chronic pelvic pain, dysmenorrhea, dyspareunia, urinary tract symptoms, and it is frequently associated with infertility. The peak of incidence is between 24 and 29 years old and the clinical diagnosis of endometriosis is generally delayed by 6-7 years. Laparoscopy with surgical biopsies is the "gold standard" for the diagnosis of endometriosis, with histological verification of endometrial ectopic glands and/or stroma. However, nowadays two different non-invasive modalities are routinely used for a presumptive diagnosis: Transvaginal Ultrasound (TVUS) and Magnetic Resonance Imaging (MRI). EVIDENCE ACQUISITION A structured search using PubMed was performed starting from October 2020 and including all relevant original and review articles published since 2000. The search used the following key word combinations: "Endometriosis MRI" AND "DIE and MRI" (45); "MRI endometriosis and Pelvic Pain" OR "Endometriosis and MRI technical development" (296). Ultimately, 87 articles were deemed relevant and used as the literature basis of this review. EVIDENCE SYNTHESIS TVUS represents the first imaging approach for endometriosis showing a good diagnostic performance but it is highly operator dependent. MRI is a second level examination often used in complex cases indeterminate after TVUS and in pre-operative planning. MRI is considered the best imaging technique for mapping endometriosis since it provides a more reliable map of deep infiltrating endometriosis than physical examination and transvaginal ultrasound. We have analyzed and described the main forms of endometriosis: adnexal endometriosis, adenomyosis, peritoneal implants and deep infiltrating endometriosis, showing their appearance in the two imaging modalities. CONCLUSIONS Endometriosis is one of the most common gynecologic disorders correlated to chronic pelvic pain whose treatment is still today complex and controversial. In this context, MRI has become an important additional non-invasive tool to investigate cases of chronic pelvic pain related to deep infiltrating endometriosis (DIE) with or without neural involvement.
Collapse
Affiliation(s)
- Veronica Celli
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy
| | - Sandra Ciulla
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy
| | - Miriam Dolciami
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy
| | - Serena Satta
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy
| | - Giada Ercolani
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy
| | - Maria G Porpora
- Department of Maternal and Child Health and Urological Sciences, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy
| | - Lucia Manganaro
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy - lucia.manganaro@uniroma1
| |
Collapse
|
20
|
Yeap PM, Szewczyk-Bieda M, Zealley I. Findings beyond Crohn's disease encountered on magnetic resonance enterography: a pictorial review of diseases inside and outside the bowel. Singapore Med J 2021; 62:173-181. [PMID: 33948670 DOI: 10.11622/smedj.2021038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Phey Ming Yeap
- Department of Radiology, Sengkang General Hospital, Singapore
| | | | - Ian Zealley
- Department of Radiology, Ninewells Hospital, Dundee, United Kingdom
| |
Collapse
|
21
|
Chandramohan A, Bhat TA, John R, Simon B. Multimodality imaging review of complex pelvic lesions in female pelvis. Br J Radiol 2020; 93:20200489. [DOI: 10.1259/bjr.20200489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Complex pelvic lesions can originate from various anatomical structures in the pelvis and pose a diagnostic dilemma due to a wide range of possible diagnoses. Accurate characterisation of these lesions would often require an algorithmic approach, which incorporates clinical findings, sequential use of multiple imaging modalities and a multiparametric approach. This approach usually aims at identifying key imaging features, which aid in anatomical localisation, morphology and tissue characterisation. There have been various attempts to standardise the lexicon used for describing adnexal masses in female patients; stratify their risk of cancer and suggest appropriate next steps in the management pathway. Through this review, we extend this approach to complex pelvic masses in female pelvis in general and will focus on optimal use of different imaging modalities to arrive at definitive diagnosis or meaningful differential diagnosis. We will also discuss potential pitfalls of imaging diagnosis and common mimics.
Collapse
Affiliation(s)
| | | | - Reetu John
- Department of Radiology, Christian Medical College, Vellore, India
| | - Betty Simon
- Department of Radiology, Christian Medical College, Vellore, India
| |
Collapse
|
22
|
The T2 Dark Spot Sign in Endometrioma. J Belg Soc Radiol 2020; 104:74. [PMID: 33336145 PMCID: PMC7716791 DOI: 10.5334/jbsr.2271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Teaching Point: The T2 dark spot sign has low sensitivity but high specificity for endometrioma on MR imaging.
Collapse
|
23
|
Infertility in women with bowel endometriosis: first-line assisted reproductive technology results in satisfactory cumulative live-birth rates. Fertil Steril 2020; 115:692-701. [PMID: 33276963 DOI: 10.1016/j.fertnstert.2020.09.032] [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] [Received: 06/04/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate the assisted reproductive technology (ART) cumulative live-birth rate (LBR) in a cohort of bowel endometriosis patients with no prior history of surgery for endometriosis. DESIGN Prospective cohort study. SETTING University hospital. PATIENT(S) One hundred and one consecutive infertile bowel-endometriosis patients with no prior history of surgery for endometriosis in whom the diagnosis of endometriosis was based on published imaging criteria using transvaginal sonography and magnetic resonance imaging. INTERVENTION(S) First-line ART. MAIN OUTCOME MEASURE(S) Cumulative LBR, with statistical analysis via Kaplan Meier method with a "conservative" method, whereby it was assumed that no live births took place for patients who did not return. RESULT(S) Between January 2016 and December 2018, 101 bowel endometriosis patients underwent 176 ART cycles. The mean number of deep-infiltrating endometriosis lesions per patient was 3 ± 0.9, with a mean number of bowel lesions of 1.3 ± 0.6. Seventy-three percent of the patients had associated endometriomas, and 88.1% had associated adenomyosis. Overall, the cumulative LBR after four ART cycles was 64.4%, using the conservative Kaplan-Meier method. CONCLUSION(S) The ART cumulative LBR was very satisfactory (64.4%) in bowel endometriosis patients with no prior history of surgery for endometriosis. In light of these data, clinicians should carefully weigh the pros and cons before systematically referring infertile bowel endometriosis patients to fertility-preserving surgery because as first-line ART appears to offer satisfactory results.
Collapse
|
24
|
Differentiation of Endometriomas from Ovarian Hemorrhagic Cysts at Magnetic Resonance: The Role of Texture Analysis. ACTA ACUST UNITED AC 2020; 56:medicina56100487. [PMID: 32977428 PMCID: PMC7598287 DOI: 10.3390/medicina56100487] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/14/2020] [Accepted: 09/20/2020] [Indexed: 11/16/2022]
Abstract
Background and Objectives: To assess ovarian cysts with texture analysis (TA) in magnetic resonance (MRI) images for establishing a differentiation criterion for endometriomas and functional hemorrhagic cysts (HCs) that could potentially outperform their classic MRI diagnostic features. Materials and Methods: Forty-three patients with known ovarian cysts who underwent MRI were retrospectively included (endometriomas, n = 29; HCs, n = 14). TA was performed using dedicated software based on T2-weighted images, by incorporating the whole lesions in a three-dimensional region of interest. The most discriminative texture features were highlighted by three selection methods (Fisher, probability of classification error and average correlation coefficients, and mutual information). The absolute values of these parameters were compared through univariate, multivariate, and receiver operating characteristic analyses. The ability of the two classic diagnostic signs ("T2 shading" and "T2 dark spots") to diagnose endometriomas was assessed by quantifying their sensitivity (Se) and specificity (Sp), following their conventional assessment on T1-and T2-weighted images by two radiologists. Results: The diagnostic power of the one texture parameter that was an independent predictor of endometriomas (entropy, 75% Se and 100% Sp) and of the predictive model composed of all parameters that showed statistically significant results at the univariate analysis (100% Se, 100% Sp) outperformed the ones shown by the classic MRI endometrioma features ("T2 shading", 75.86% Se and 35.71% Sp; "T2 dark spots", 55.17% Se and 64.29% Sp). Conclusion: Whole-lesion MRI TA has the potential to offer a superior discrimination criterion between endometriomas and HCs compared to the classic evaluation of the two lesions' MRI signal behaviors.
Collapse
|
25
|
Lupean RA, Ștefan PA, Feier DS, Csutak C, Ganeshan B, Lebovici A, Petresc B, Mihu CM. Radiomic Analysis of MRI Images is Instrumental to the Stratification of Ovarian Cysts. J Pers Med 2020; 10:jpm10030127. [PMID: 32937851 PMCID: PMC7563604 DOI: 10.3390/jpm10030127] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 08/25/2020] [Accepted: 09/09/2020] [Indexed: 12/13/2022] Open
Abstract
The imaging diagnosis of malignant ovarian cysts relies on their morphological features, which are not always specific to malignancy. The histological analysis of these cysts shows specific fluid characteristics, which cannot be assessed by conventional imaging techniques. This study investigates whether the texture-based radiomics analysis (TA) of magnetic resonance (MRI) images of the fluid content within ovarian cysts can function as a noninvasive tool in differentiating between benign and malignant lesions. Twenty-eight patients with benign (n = 15) and malignant (n = 13) ovarian cysts who underwent MRI examinations were retrospectively included. TA of the fluid component was undertaken on an axial T2-weighted sequence. A comparison of resulted parameters between benign and malignant groups was undertaken using univariate, multivariate, multiple regression, and receiver operating characteristics analyses, with the calculation of the area under the curve (AUC). The standard deviation of pixel intensity was identified as an independent predictor of malignant cysts (AUC = 0.738; sensitivity, 61.54%; specificity, 86.67%). The prediction model was able to identify malignant lesions with 84.62% sensitivity and 80% specificity (AUC = 0.841). TA of the fluid contained within the ovarian cysts can differentiate between malignant and benign lesions and potentially act as a noninvasive tool augmenting the imaging diagnosis of ovarian cystic lesions.
Collapse
Affiliation(s)
- Roxana-Adelina Lupean
- Histology, Morphological Sciences Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, Louis Pasteur Street, number 4, Cluj-Napoca, 400349 Cluj, Romania; (R.-A.L.); (C.M.M.)
- Obstetrics and Gynecology Clinic “Dominic Stanca”, County Emergency Hospital, 21 Decembrie 1989 Boulevard, number 55, Cluj-Napoca, 400094 Cluj, Romania
| | - Paul-Andrei Ștefan
- Anatomy and Embryology, Morphological Sciences Department, “Iuliu Haţieganu” University of Medicine and Pharmacy, Victor Babeș Street, number 8, Cluj-Napoca, 400012 Cluj, Romania
- Radiology and Imaging Department, County Emergency Hospital, Cluj-Napoca, Clinicilor Street, number 5, Cluj-Napoca, 400006 Cluj, Romania; (C.C.); (A.L.); (B.P.)
- Correspondence: (P.-A.Ș.); (D.S.F.); Tel.: +40-743957206 (P.-A.Ș.); +40-740537872 (D.S.F.); Fax: +40-264596085 (P.-A.Ș.)
| | - Diana Sorina Feier
- Radiology and Imaging Department, County Emergency Hospital, Cluj-Napoca, Clinicilor Street, number 5, Cluj-Napoca, 400006 Cluj, Romania; (C.C.); (A.L.); (B.P.)
- Radiology, Surgical Specialties Department, “Iuliu Haţieganu” University of Medicine and Pharmacy, Clinicilor Street, number 3-5, Cluj-Napoca, 400006 Cluj, Romania
- Correspondence: (P.-A.Ș.); (D.S.F.); Tel.: +40-743957206 (P.-A.Ș.); +40-740537872 (D.S.F.); Fax: +40-264596085 (P.-A.Ș.)
| | - Csaba Csutak
- Radiology and Imaging Department, County Emergency Hospital, Cluj-Napoca, Clinicilor Street, number 5, Cluj-Napoca, 400006 Cluj, Romania; (C.C.); (A.L.); (B.P.)
- Radiology, Surgical Specialties Department, “Iuliu Haţieganu” University of Medicine and Pharmacy, Clinicilor Street, number 3-5, Cluj-Napoca, 400006 Cluj, Romania
| | - Balaji Ganeshan
- Institute of Nuclear Medicine, University College London Hospitals NHS Trust, 235 Euston Road, London NW1 2BU, UK;
| | - Andrei Lebovici
- Radiology and Imaging Department, County Emergency Hospital, Cluj-Napoca, Clinicilor Street, number 5, Cluj-Napoca, 400006 Cluj, Romania; (C.C.); (A.L.); (B.P.)
- Radiology, Surgical Specialties Department, “Iuliu Haţieganu” University of Medicine and Pharmacy, Clinicilor Street, number 3-5, Cluj-Napoca, 400006 Cluj, Romania
| | - Bianca Petresc
- Radiology and Imaging Department, County Emergency Hospital, Cluj-Napoca, Clinicilor Street, number 5, Cluj-Napoca, 400006 Cluj, Romania; (C.C.); (A.L.); (B.P.)
| | - Carmen Mihaela Mihu
- Histology, Morphological Sciences Department, “Iuliu Hațieganu” University of Medicine and Pharmacy, Louis Pasteur Street, number 4, Cluj-Napoca, 400349 Cluj, Romania; (R.-A.L.); (C.M.M.)
- Radiology and Imaging Department, County Emergency Hospital, Cluj-Napoca, Clinicilor Street, number 5, Cluj-Napoca, 400006 Cluj, Romania; (C.C.); (A.L.); (B.P.)
| |
Collapse
|
26
|
Mao A, Rana HN, Steffler B, Figarola S. Post-Cesarean Section Abdominal Wall Endometrioma. Cureus 2020; 12:e10088. [PMID: 33005511 PMCID: PMC7522165 DOI: 10.7759/cureus.10088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
A 30-year-old female with a history of multiple cesarean sections presents to the emergency department with several months of right lower quadrant abdominal pain only associated with her menstrual cycles. CT abdomen and pelvis with contrast was remarkable for an abdominal wall mass that likely represented an endometrioma, and she was subsequently discharged with pain medications and conservative treatment. However, three months later, she returned to the ED, because her pain was unbearable and refractory to medical management. Interventional radiology was consulted for percutaneous biopsy of the soft tissue mass located in her rectus abdominus muscle. Following the procedure, the patient was started on ORILISSA® (elagolix), the first FDA-approved oral treatment for the management of severe pain associated with endometriosis. We highlight an interesting case of post-cesarean section abdominal wall endometrioma implantation and describe the patient’s clinical course and disease management. The radiographic features of the mass are described and proposed mechanisms for the development of an abdominal wall endometrioma following a C-section is discussed.
Collapse
|
27
|
Risk of small for gestational age is reduced after frozen compared with fresh embryo transfer in endometriosis. Reprod Biomed Online 2020; 42:133-141. [PMID: 33077356 DOI: 10.1016/j.rbmo.2020.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 07/24/2020] [Accepted: 08/12/2020] [Indexed: 01/01/2023]
Abstract
RESEARCH QUESTION What are the perinatal outcomes and especially the risk of small for gestational age (SGA) babies born after frozen versus fresh embryo transfer in mothers affected by endometriosis undergoing treatment with assisted reproductive technology (ART)? DESIGN A cohort study conducted between November 2012 and October 2017, in which infertile women with endometriosis undergoing ART and achieving singleton pregnancies that lasted beyond 12 weeks of gestation were included. Pregnancies obtained after a frozen embryo transfer (FET) were compared with those obtained after a fresh embryo transfer. A total of 339 pregnant women were included: 112 patients in the fresh embryo transfer group and 227 in the FET group. The main outcome was the rate of SGA. Secondary analyses were performed for adverse pregnancy outcomes and perinatal complications. RESULTS Of the included women, 109/112 (97.3%) and 222/227 (97.8%) delivered a live child after at least 24 weeks of gestation in the fresh and in the frozen embryo transfer groups, respectively (P = 0.53). The risk of SGA decreased after a FET compared with a fresh embryo transfer (odds ratio [OR] 0.49 [0.25-0.98], P = 0.04) after multivariable analysis. The mean birthweight and the gestational age at delivery were not significantly different between the two study groups. Other pregnancy and perinatal complications were not statistically different between the two study populations. CONCLUSIONS The present study of endometriosis-affected women found a significantly lower risk of SGA in patients undergoing frozen, mainly blastocyst, embryo transfer compared with patients undergoing fresh, mainly cleavage stage, embryo transfer.
Collapse
|
28
|
Cope AG, VanBuren WM, Sheedy SP. Endometriosis in the postmenopausal female: clinical presentation, imaging features, and management. Abdom Radiol (NY) 2020; 45:1790-1799. [PMID: 31701193 DOI: 10.1007/s00261-019-02309-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Postmenopausal endometriosis is an important clinical entity which is likely under-recognized and in which the Radiologist can play a valuable role. In this review, we describe the clinical presentation and management of postmenopausal endometriosis, appraising the literature and providing case examples. Persons with postmenopausal endometriosis may present with symptoms including pelvic pain or dyschezia, but endometriosis may also be an asymptomatic, incidental finding. Women may or may not have a prior history of endometriosis or a history of symptoms consistent with it. Therapies and conditions which increase exogenous or endogenous estrogen, respectively, increase the risk. Endometriosis can be found in different locations throughout the body, and the possibility of malignancy should be assessed, especially in the postmenopausal population, where age increases cancer risk. Treatment may involve surgery or medical interventions. Guidelines describing appropriate imaging surveillance in these patients are lacking. In the postmenopausal population, Radiologists need to consider endometriosis as a diagnosis, recommend appropriate exams such as MRI and US, and suggest endometriosis-associated malignancies when appropriate, based on classic morphologic features.
Collapse
Affiliation(s)
- Adela G Cope
- Department of Obstetrics and Gynecology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Wendaline M VanBuren
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Shannon P Sheedy
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| |
Collapse
|
29
|
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.
Collapse
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
| |
Collapse
|
30
|
Abstract
Endometriosis constitutes the presence of ectopic endometrial glands and stroma outside the uterine endometrium, which is hormonally responsive and responds to pregnancy hormones as well. Decidualization is a physiologic process, where the normal endometrium readies itself for optimal accommodation of a pregnancy. A similar hormonal response can be seen with ectopic endometrium as well. As such, ovarian endometriomas and deep endometriosis implants can undergo decidualization. Overall, the progestational state of pregnancy favors an improvement in endometriosis, however, decidualization can lead to findings that can lead to increased size of endometriomas and deep infiltrative endometriosis implants, changes in imaging appearance and even complications, such as spontaneous hemoperitoneum in pregnancy. Awareness of this process can help prevent misdiagnosis of decidualized endometriomas as ovarian malignancy and recognize common imaging manifestations of hormonal effects of pregnancy on endometriosis.
Collapse
|
31
|
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.
Collapse
|
32
|
Wall DJ, Reinhold C, Akin EA, Ascher SM, Brook OR, Dassel M, Henrichsen TL, Learman LA, Maturen KE, Patlas MN, Robbins JB, Sadowski EA, Saphier C, Uyeda JW, Glanc P. ACR Appropriateness Criteria® Female Infertility. J Am Coll Radiol 2020; 17:S113-S124. [PMID: 32370955 DOI: 10.1016/j.jacr.2020.01.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 01/30/2020] [Indexed: 12/12/2022]
Abstract
The most common known causes of female infertility are male factor (26%), ovulatory failure (21%), and tubal damage (14%), while in 28% a couple's infertility remains unexplained. Female-specific causes of infertility include deterioration of oocyte quality with increasing maternal age; ovulatory disorders, most notably polycystic ovarian syndrome; history of salpingitis such as that caused by chlamydia infection; endometriosis; and uterine cavity abnormalities interfering with implantation causing inability to become pregnant or causing recurrent pregnancy loss. These potential causes of female infertility are discussed in this document and the appropriate imaging recommendations for each variant are provided. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Collapse
Affiliation(s)
| | | | - Esma A Akin
- George Washington University Hospital, Washington, District of Columbia
| | - Susan M Ascher
- Georgetown University Hospital, Washington, District of Columbia
| | - Olga R Brook
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Mark Dassel
- Cleveland Clinic, Cleveland, Ohio; American College of Obstetricians and Gynecologists
| | | | - Lee A Learman
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia; American College of Obstetricians and Gynecologists
| | | | | | | | | | - Carl Saphier
- Women's Ultrasound, LLC, Englewood, New Jersey; American College of Obstetricians and Gynecologists
| | | | - Phyllis Glanc
- Specialty Chair, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| |
Collapse
|
33
|
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]
|
34
|
Abstract
This article provides an overview of the imaging evaluation of benign ovarian and adnexal masses in premenopausal and postmenopausal women and lesions discovered during pregnancy. Current imaging techniques are discussed, including pitfalls and differential diagnosis when necessary, as well as management. It also reviews the now well-established American College of Radiology (ACR)/Society of Radiologists in Ultrasound consensus guidelines and covers the more recently introduced Ovarian-Adnexal Reporting and Data System by the ACR and the recently published ADNEx Scoring System.
Collapse
Affiliation(s)
- Nadia J Khati
- Department of Radiology, Abdominal Imaging Section, The George Washington University Hospital, 900 23rd Street, Northwest, Washington, DC 20037, USA.
| | - Tammy Kim
- Department of Radiology, Abdominal Imaging Section, The George Washington University Hospital, 900 23rd Street, Northwest, Washington, DC 20037, USA
| | - Joanna Riess
- Department of Radiology, Abdominal Imaging Section, The George Washington University Hospital, 900 23rd Street, Northwest, Washington, DC 20037, USA
| |
Collapse
|
35
|
Moura APC, Novis MI, Demarchi GTS, Fernandes LM, D'Ippolito G, Torres US, Chamié LP. Pelvic hemorrhagic lesions in women: MRI findings and differential diagnosis. Clin Imaging 2019; 60:16-25. [PMID: 31864195 DOI: 10.1016/j.clinimag.2019.12.008] [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: 10/14/2019] [Revised: 11/25/2019] [Accepted: 12/09/2019] [Indexed: 10/25/2022]
Abstract
A large spectrum of pathologic pelvic conditions can present with hemorrhage in structures or organs. These may present acutely, subacutely, chronically or as incidental findings. Clinical history and MRI characteristics can often narrow the differential diagnosis and guide management. The purpose of this article is to showcase a wide array of pelvic lesions, in which the presence of blood is a key imaging feature, and their differential diagnosis.
Collapse
Affiliation(s)
- Ana Paula Carvalhal Moura
- Grupo Fleury, Rua Cincinato Braga, 282, Bela Vista, São Paulo, SP 01333-010, Brazil; Gynecological Endoscopy and Endometriosis Sector, Department of Obstetrics and Gynecology, Santa Casa de São Paulo School of Medical Science, Rua Dr. Cesário Mota Júnior, 112, Vila Buarque, São Paulo, SP 01221-020, Brazil.
| | - Maria Inês Novis
- Grupo Fleury, Rua Cincinato Braga, 282, Bela Vista, São Paulo, SP 01333-010, Brazil.
| | | | - Lizieux Matos Fernandes
- Gynecological Endoscopy and Endometriosis Sector, Department of Obstetrics and Gynecology, Santa Casa de São Paulo School of Medical Science, Rua Dr. Cesário Mota Júnior, 112, Vila Buarque, São Paulo, SP 01221-020, Brazil
| | - Giuseppe D'Ippolito
- Grupo Fleury, Rua Cincinato Braga, 282, Bela Vista, São Paulo, SP 01333-010, Brazil; Hospital Sao Paulo, Universidade Federal de Sao Paulo (UNIFESP), Rua Napoleão de Barros, 800, Vila Clementino, São Paulo, SP 04024-002, Brazil.
| | - Ulysses S Torres
- Grupo Fleury, Rua Cincinato Braga, 282, Bela Vista, São Paulo, SP 01333-010, Brazil.
| | | |
Collapse
|
36
|
Beker K, Lee KS, Tsai LL, Hegazi T, Garces-Descovich A, Brook A, Mortele KJ. Differentiation of pancreatic head ductal adenocarcinoma from inflammatory pancreatic pseudomass by MR cholangio-pancreatography: utility of the duct-interrupted, corona, and attraction signs. Abdom Radiol (NY) 2019; 44:4048-4056. [PMID: 31352623 DOI: 10.1007/s00261-019-02155-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE To determine sensitivity and specificity of the "duct-interrupted," "corona," and "attraction" signs on MR cholangio-pancreatography (MRCP) in distinguishing pancreatic head ductal adenocarcinoma (PDAC) from inflammatory pancreatic pseudomass (IPP). MATERIALS AND METHODS This study included 53 adults (33 men and 20 women, mean age, 55 years; range, 17-87 years) with a pancreatic head mass who underwent MRCP. Three blinded radiologists independently reviewed each MRCP exam and three signs were assessed: (1) the "duct-interrupted" sign, deemed positive for PDAC if the duct within the mass demonstrated complete interruption with upstream dilation; (2) the "corona" sign, considered positive for PDAC if dilated side-branches were located exclusively outside the mass; and (3) the "attraction" sign, deemed positive for IPP if the dilated common bile duct showed attraction and angulation towards the mass. Sensitivity, specificity, and positive and negative predictive values of the signs were calculated, as well as interobserver agreement. RESULTS Out of 53 masses, 17 (32%) were PDAC and 36 (68%) were IPP. Sensitivity, specificity, and positive and negative predictive values of the "duct-interrupted" sign to differentiate between PDAC from IPP for the three readers were 29-53%, 89-95%, 56-82% and 73-81%, respectively (κ = 0.41); for the "corona" sign, they were 29-53%, 81-100%, 56-100%, and 75-78%, respectively (κ = 0.4), and for the "attraction" sign, they were 20-25%, 71-82%, 64-75%, and 31-34%, respectively (κ = 0.54). CONCLUSION The "duct-interrupted" and "corona" MRCP signs have high specificity for diagnosing PDAC, while the "attraction" sign has good specificity for identifying IPP.
Collapse
Affiliation(s)
- Kevin Beker
- Division of Body MRI, Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02115, USA
| | - Karen S Lee
- Division of Body MRI, Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02115, USA
| | - Leo L Tsai
- Division of Body MRI, Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02115, USA
| | - Tarek Hegazi
- Division of Body MRI, Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02115, USA
| | - Alejandro Garces-Descovich
- Division of Body MRI, Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02115, USA
| | - Alexander Brook
- Division of Body MRI, Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02115, USA.
| | - Koenraad J Mortele
- Division of Body MRI, Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02115, USA
| |
Collapse
|
37
|
Brusic A, Esler S, Churilov L, Chowdary P, Sleeman M, Maher P, Yang N. Deep infiltrating endometriosis: Can magnetic resonance imaging anticipate the need for colorectal surgeon intervention? Eur J Radiol 2019; 121:108717. [PMID: 31739271 DOI: 10.1016/j.ejrad.2019.108717] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 05/27/2019] [Accepted: 10/18/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To identify magnetic resonance imaging (MRI) features associated with colorectal surgical bowel resection for treatment of deep infiltrating endometriosis (DIE). MATERIALS AND METHODS 122 preoperative pelvic MRIs in women with laparoscopically-proven DIE and subsequent surgery (2006-2015) were identified, and retrospective cohort analysis performed. MRIs were reviewed independently by two radiologists blinded to surgical/histopathological outcomes. Associations between MRI characteristics of middle/posterior compartment endometriosis and surgical outcomes were investigated to identify MRI features associated with colorectal surgical bowel resection. RESULTS MRI features associated with colorectal surgical intervention were: presence of an MRI bowel lesion (sensitivity 95.3%, specificity 63.3%, ROC-AUC 0.79); MRI bowel lesions ≥20 mm in length (sensitivity 91%, specificity 77%, ROC-AUC 0.84); MRI bowel lesions invading the muscularis or submucosa/mucosa layers (sensitivity 95.3%, specificity 63.3%, ROC-AUC 0.90). CONCLUSION This study identifies MRI features that have potential diagnostic utility in identifying the need for colorectal surgical intervention in patients with DIE.
Collapse
Affiliation(s)
- Ana Brusic
- Austin Hospital, Radiology Department, Level 2 Lance Townsend Building, 145 Studley Rd, Heidelberg, Victoria, 3084, Australia.
| | - Stephen Esler
- Austin Hospital, Radiology Department, Level 2 Lance Townsend Building, 145 Studley Rd, Heidelberg, Victoria, 3084, Australia
| | - Leonid Churilov
- Florey Institute of Neuroscience & Mental Health, Statistics and Decision Analysis Academic Platform, 245 Burgundy St Heidelberg, Victoria, 3084, Australia
| | - Prathima Chowdary
- Mercy Hospital for Women, Endosurgical Unit, 163 Studley Rd, Heidelberg, Victoria, 3084, Australia
| | - Matthew Sleeman
- Mercy Hospital for Women, Endosurgical Unit, 163 Studley Rd, Heidelberg, Victoria, 3084, Australia
| | - Peter Maher
- Mercy Hospital for Women, Endosurgical Unit, 163 Studley Rd, Heidelberg, Victoria, 3084, Australia
| | - Natalie Yang
- Austin Hospital, Radiology Department, Level 2 Lance Townsend Building, 145 Studley Rd, Heidelberg, Victoria, 3084, Australia
| |
Collapse
|
38
|
Diagnostic Efficacy of T2 Dark Spot, T2 Dark Rim Signs, and T2 Shading on Magnetic Resonance Imaging in Differentiating Endometriomas From Hemorrhagic Cysts. J Comput Assist Tomogr 2019; 43:619-622. [PMID: 31268877 DOI: 10.1097/rct.0000000000000892] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE This study aimed to evaluate the diagnostic efficacy of T2 dark spot, T2 dark rim, and T2 shading signs on magnetic resonance imaging in the differentiation of endometriomas from hemorrhagic cysts. METHODS Seventy-two hemorrhagic lesions were included in this retrospective study. The presence of T2 dark spot, T2 dark rim, and T2 shading signs in the lesions and the presence of complete or incomplete rim in lesions exhibiting T2 dark rim signs were evaluated. RESULTS Of 72 lesions, 50 were diagnosed with endometrioma and 22 were diagnosed with hemorrhagic cyst. Twenty-six of 50 endometriomas and none of the hemorrhagic cysts showed T2 dark spot sign. T2 shading was observed in 90% of endometriomas and 18% of hemorrhagic cysts. Incomplete T2 dark rim was detected in 67% of endometriomas and 21% of hemorrhagic cysts. CONCLUSIONS T2 dark spot and T2 dark rim signs could be useful for distinguishing endometriomas from hemorrhagic cysts.
Collapse
|
39
|
Montoriol PF, Magnin B, Penault-Llorca F. Imagerie des transformations malignes de l’endométriose pelvienne. IMAGERIE DE LA FEMME 2019. [DOI: 10.1016/j.femme.2019.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
40
|
Son JK, Ali S, Al Khori N, Lee EY. MR Imaging Evaluation of Pediatric Genital Disorders:. Magn Reson Imaging Clin N Am 2019; 27:301-321. [DOI: 10.1016/j.mric.2019.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
41
|
Abstract
Developments in magnetic resonance imaging have expanded its role in the assessment of the female pelvis, including the diagnosis of ovarian lesions. In this setting, diffusion-weighted imaging has proven its diagnostic value, which is particularly important in differentiating between benign and malignant ovarian tumors. In general, the latter show restricted diffusion, whereas the former do not. Exceptions include teratomas, endometriomas, hemorrhagic cysts, ovarian abscesses, ovarian infarction, and some benign stromal tumors. The aim of this review is to draw attention to benign ovarian lesions with restricted diffusion, with a special focus on diffusion-weighted imaging pearls and pitfalls.
Collapse
Affiliation(s)
| | - Mariana Horta
- Instituto Português de Oncologia de Lisboa Francisco Gentil - Radiologia, Lisboa, Portugal
| | - João Cunha Salvador
- Instituto Português de Oncologia de Lisboa Francisco Gentil - Radiologia, Lisboa, Portugal
| | - Teresa Margarida Cunha
- Instituto Português de Oncologia de Lisboa Francisco Gentil - Radiologia, Lisboa, Portugal
| |
Collapse
|
42
|
Abstract
Endometriosis is a common disease of reproductive-age women that is often first encountered with ultrasound. Therefore, familiarity with the variety of manifestations of endometriosis is important for appropriate diagnosis and management. The aim of this article is to review the spectrum of appearance of pelvic endometriosis and to discuss potential mimics on ultrasound. Given that magnetic resonance imaging is an important problem-solving tool in female pelvic imaging, magnetic resonance imaging correlation is also provided.
Collapse
|
43
|
Kurzbard-Roach N, Jha P, Poder L, Menias C. Abdominal and pelvic imaging findings associated with sex hormone abnormalities. Abdom Radiol (NY) 2019; 44:1103-1119. [PMID: 30483844 DOI: 10.1007/s00261-018-1844-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Hormones are substances that serve as chemical communication between cells. They are unique biological molecules that affect multiple organ systems and play a key role in maintaining homoeostasis. In this role, they are usually produced from a single organ and have defined target organs. However, hormones can affect non-target organs as well. As such, biochemical and hormonal abnormalities can be associated with anatomic changes in multiple target as well as non-target organs. Hormone-related changes may take the form of an organ parenchymal abnormality, benign neoplasm, or even malignancy. Given the multifocal action of hormones, the observed imaging findings may be remote from the site of production, and may actually be multi-organ in nature. Anatomic findings related to hormone level abnormalities and/or laboratory biomarker changes may be identified with imaging. The purpose of this image-rich review is to sensitize radiologists to imaging findings in the abdomen and pelvis that may occur in the context of hormone abnormalities, focusing primarily on sex hormones and their influence on these organs.
Collapse
Affiliation(s)
- Nicole Kurzbard-Roach
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Priyanka Jha
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA.
| | - Liina Poder
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | | |
Collapse
|
44
|
|
45
|
Endometriosis and ART: A prior history of surgery for OMA is associated with a poor ovarian response to hyperstimulation. PLoS One 2018; 13:e0202399. [PMID: 30125306 PMCID: PMC6101383 DOI: 10.1371/journal.pone.0202399] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 08/02/2018] [Indexed: 12/20/2022] Open
Abstract
Background Many women whose fertility may have been impaired by endometriosis require assisted reproductive technology (ART) in order to become pregnant. However, the influence of ovarian endometriosis (OMA) on ovarian responsiveness to hyperstimulation has not been clearly established. Objective To evaluate the risk of a poor ovarian response (POR) to stimulation and ART outcomes in women with OMA. Materials and methods We conducted a large observational controlled matched cohort study in a tertiary care university hospital between 01/10/2012 and 31/12/2015. After matching by age and anti-Müllerian hormone (AMH) levels, 201 infertile women afflicted with OMA (the OMA group) and 402 disease-free women (the control group) undergoing an ART procedure were included in the study. The main outcomes that we measured were a POR to hyperstimulation (i.e., ≤ 3 oocytes retrieved, or cancelled cycles), the clinical pregnancy rate, and the live birth rate. All of the women with endometriosis underwent a pre-ART work-up, in order to obtain an accurate diagnosis and staging of their disease. An OMA diagnosis was based on published imaging criteria (obtained by transvaginal sonography or magnetic resonance imaging) or on histological analysis for patients with a prior history of endometriosis surgery. The statistical analyses were conducted using univariate and multivariate logistic regression models. Results The incidence of a POR to hyperstimulation was significantly higher for the OMA group than for the control group [62/201 (30.8%) versus 90/402 (22.3%), respectively; p = 0.02]. However, no significant differences were found between the OMA and the control group in terms of the clinical pregnancy rate [53/151 (35%) versus 134/324 (41.3%), respectively; p = 0.23] and the live birth rate [39/151 (25.8%) versus 99/324 (30.5%), respectively; p = 0.33]. By multivariate analysis, a prior history of surgery for OMA was found to be an independent factor associated with a POR to stimulation [OR = 2.1; 95% CI: 1.1–4.0], unlike OMA without a prior history of surgery [OR: 1.5; 95% CI: 0.9–2.2]. Conclusion The presence of OMA during ART treatment increased the risk of a POR to hyperstimulation, although the live birth rate was not affected. Furthermore, having OMA and having previously undergone surgery for OMA was identified as an independent risk factor for a POR.
Collapse
|
46
|
Nishio N, Kido A, Kataoka M, Kuwahara R, Nakao K, Kurata Y, Matsumura N, Mandai M, Togashi K. Longitudinal changes in magnetic resonance imaging of malignant and borderline tumors associated with ovarian endometriotic cyst comparing with endometriotic cysts without arising malignancy. Eur J Radiol 2018; 105:175-181. [DOI: 10.1016/j.ejrad.2018.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 06/01/2018] [Accepted: 06/11/2018] [Indexed: 11/30/2022]
|
47
|
Bourdon M, Santulli P, Maignien C, Gayet V, Pocate-Cheriet K, Marcellin L, Chapron C. The deferred embryo transfer strategy improves cumulative pregnancy rates in endometriosis-related infertility: A retrospective matched cohort study. PLoS One 2018; 13:e0194800. [PMID: 29630610 PMCID: PMC5890985 DOI: 10.1371/journal.pone.0194800] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 03/10/2018] [Indexed: 12/22/2022] Open
Abstract
Background Controlled ovarian stimulation in assisted reproduction technology (ART) may alters endometrial receptivity by an advancement of endometrial development. Recently, technical improvements in vitrification make deferred frozen-thawed embryo transfer (Def-ET) a feasible alternative to fresh embryo transfer (ET). In endometriosis-related infertility the eutopic endometrium is abnormal and its functional alterations are seen as likely to alter the quality of endometrial receptivity. One question in the endometriosis ART-management is to know whether Def-ET could restore optimal receptivity in endometriosis-affected women leading to increase in pregnancy rates. Objective To compare cumulative ART-outcomes between fresh versus Def-ET in endometriosis-infertile women. Materials and methods This matched cohort study compared def-ET strategy to fresh ET strategy between 01/10/2012 and 31/12/2014. One hundred and thirty-five endometriosis-affected women with a scheduled def-ET cycle and 424 endometriosis-affected women with a scheduled fresh ET cycle were eligible for matching. Matching criteria were: age, number of prior ART cycles, and endometriosis phenotype. Statistical analyses were conducted using univariable and multivariable logistic regression models. Results 135 in the fresh ET group and 135 in the def-ET group were included in the analysis. The cumulative clinical pregnancy rate was significantly increased in the def-ET group compared to the fresh ET group [58 (43%) vs. 40 (29.6%), p = 0.047]. The cumulative ongoing pregnancy rate was 34.8% (n = 47) and 17.8% (n = 24) respectively in the Def-ET and the fresh-ET groups (p = 0.005). After multivariable conditional logistic regression analysis, Def-ET was associated with a significant increase in the cumulative ongoing pregnancy rate as compared to fresh ET (OR = 1.76, CI95% 1.06–2.92, p = 0.028). Conclusion Def-ET in endometriosis-affected women was associated with significantly higher cumulative ongoing pregnancy rates. Our preliminary results suggest that Def-ET for endometriosis-affected women is an attractive option that could increase their ART success rates. Future studies, with a randomized design, should be conducted to further confirm those results.
Collapse
Affiliation(s)
- Mathilde Bourdon
- Department of Gynecology Obstetrics II and Reproductive Medicine, Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department “Stress oxydant, prolifération cellulaire et inflammation”, Institut Cochin, INSERM U1016, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Pietro Santulli
- Department of Gynecology Obstetrics II and Reproductive Medicine, Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department “Stress oxydant, prolifération cellulaire et inflammation”, Institut Cochin, INSERM U1016, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Department “Development, Reproduction and Cancer”, Institut Cochin, INSERM U1016, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- * E-mail:
| | - Chloé Maignien
- Department of Gynecology Obstetrics II and Reproductive Medicine, Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
| | - Vanessa Gayet
- Department of Gynecology Obstetrics II and Reproductive Medicine, Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
| | - Khaled Pocate-Cheriet
- Department of Histology-Embryology and Reproductive Biology, Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
| | - Louis Marcellin
- Department of Gynecology Obstetrics II and Reproductive Medicine, Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department “Stress oxydant, prolifération cellulaire et inflammation”, Institut Cochin, INSERM U1016, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Department “Development, Reproduction and Cancer”, Institut Cochin, INSERM U1016, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Charles Chapron
- Department of Gynecology Obstetrics II and Reproductive Medicine, Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department “Stress oxydant, prolifération cellulaire et inflammation”, Institut Cochin, INSERM U1016, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- Department “Development, Reproduction and Cancer”, Institut Cochin, INSERM U1016, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| |
Collapse
|
48
|
Abstract
Diffusion-weighted imaging (DWI) is widely used in protocols for magnetic resonance imaging (MRI) of the female pelvis. It provides functional and structural information about biological tissues, without the use of ionizing radiation or intravenous administration of contrast medium. High signal intensity on DWI with simultaneous low signal intensity on apparent diffusion coefficient maps is usually associated with malignancy. However, that pattern can also be seen in many benign lesions, a fact that should be recognized by radiologists. Correlating DWI findings with those of conventional (T1- and T2-weighted) MRI sequences and those of contrast-enhanced MRI sequences is mandatory in order to avoid potential pitfalls. The aim of this review article is the description of the most relevant physiological and benign pathological conditions of the female pelvis that can show restricted diffusion on DWI.
Collapse
Affiliation(s)
- Ana Luisa Duarte
- Department of Radiology, Hospital do Espírito Santo E.P.E., Évora, Portugal
| | - João Lopes Dias
- Department of Radiology, Hospital de São José, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | - Teresa Margarida Cunha
- Department of Radiology, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| |
Collapse
|
49
|
A systematic approach to adnexal masses discovered on ultrasound: the ADNEx MR scoring system. Abdom Radiol (NY) 2018; 43:679-695. [PMID: 28900696 DOI: 10.1007/s00261-017-1272-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Adnexal lesions are a common occurrence in radiology practice and imaging plays a crucial role in triaging women appropriately. Current trends toward early detection and characterization have increased the need for accurate imaging assessment of adnexal lesions prior to treatment. Ultrasound is the first-line imaging modality for assessing adnexal lesions; however, approximately 20% of lesions are incompletely characterized after ultrasound evaluation. Secondary assessment with MR imaging using the ADNEx MR Scoring System has been demonstrated as highly accurate in the characterization of adnexal lesions and in excluding ovarian cancer. This review will address the role of MR imaging in further assessment of adnexal lesions discovered on US, and the utility of the ADNEx MR Scoring System.
Collapse
|
50
|
Thomassin-Naggara I, Bendifallah S, Rousset P, Bazot M, Ballester M, Darai E. Performances et critères de qualité de l’IRM, du colo-scanner, de l’entéro IRM/CT pour le diagnostic d’endométriose pelvienne, RPC Endométriose CNGOF-HAS. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.gofs.2018.02.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
|