{"paper_id":"634b5eb2-7076-4859-8986-3769a716477c","body_text":"Abstract\nObjective\nTo prospectively evaluate microstructural abnormalities in sacral nerve roots in women affected by chronic pelvic pain associated with endometriosis.\nMethods\nWe enrolled 30 women with an ultrasound diagnosis of endometriosis and moderate-severe chronic pelvic pain; 10 age-matched healthy women comprised the control group. All subjects underwent 3 T magnetic resonance imaging (MRI), including diffusion tensor imaging (DTI); the sacral roots were reconstructed by post-processing the DTI data with dedicated software. Mean fractional anisotropy (FA) values in the S1, S2 and S3 roots were quantified. Analysis of FA values was performed by two radiologists in order to evaluate the interobserver agreement.\nResults\nThe sacral nerve roots in healthy subjects were clearly visualised. Most of the patients with endometriosis displayed abnormalities of S1, S2 and S3 bilaterally at tractography, including an irregular and disorganised appearance. FA values in the S1, S2 and S3 roots were significantly lower in patients than in controls (P < 0.0001, <0.05 and <0.02, respectively) for both observers. No significant difference was found between observers.\nConclusion\nDTI with tractography is a non-invasive means of detecting changes in the microarchitecture of the sacral nerve roots. It can qualitatively and quantitatively reveal sacral root abnormalities in patients with endometriosis-associated pain.\nKey Points\n• MRI is increasingly used for endometriosis and chronic pelvic pain (CPP).\n• Magnetic resonance tractography can demonstrate microarchitectural abnormalities in sacral nerve roots.\n• Tractography shows altered microstructure of sacral roots affected by endometriosis and CPP.\n• S1–S3 fractional anisotropy values are lower in endometriosis than in healthy women.\n• Sacral nerve root alteration may explain the nature of endometriosis-related CPP.\nSimilar content being viewed by others\nReferences\nEskenazi B, Warner ML (1997) Epidemiology of endometriosis. Obstet Gynecol Clin North Am 24:235–258\nMeuleman C, Vandenabeele B, Fieuws S et al (2009) High prevalence of endometriosis in infertile women with normal ovulation and normospermic partners. 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Anesthesiology 85:37–42\nAcknowledgements\nParts of this article were presented in electronic poster form at ECR 2013: “Fibre tracking evaluation of sacral nervous pathways 3D architecture in women affected by endometriosis”.\nAuthor information\nAuthors and Affiliations\nCorresponding author\nRights and permissions\nAbout this article\nCite this article\nManganaro, L., Porpora, M.G., Vinci, V. et al. Diffusion tensor imaging and tractography to evaluate sacral nerve root abnormalities in endometriosis-related pain: A pilot study. Eur Radiol 24, 95–101 (2014). https://doi.org/10.1007/s00330-013-2981-0\nReceived:\nRevised:\nAccepted:\nPublished:\nIssue date:\nDOI: https://doi.org/10.1007/s00330-013-2981-0","source_license":"CC0","license_restricted":false}