[Studies on diagnosis of endometriosis by magnetic resonance imaging by means of fat saturation technique]

It is difficult to distinguish a small endometrial implant from adipose tissue by magnetic resonance imaging (MRI). I assessed the usefulness of fat saturated MRI in detecting small endometrial implants by comparing it with conventional MRI. Seventy-four patients with clinically suspected endometriosis were referred for MRI. In every patient, laparoscopy or laparotomy was performed. MRI was performed with a 1.5T superconducting magnet with spin echo T1, T2 and fat saturated T1 weighted images. Surgery revealed a normal pelvis in 6 patients, endometriosis in 65, and cystic lesions in three others. With fat saturated MRI, overall sensitivity, specificity, positive predictive value and negative predictive value were 87.7%, 66.7%, 95.0% and 42.9%, respectively. At surgery, 160 pigmented lesions of endometriosis were detected. Conventional MRI permitted identification of almost all ovarian endometriomas > 10mm in diameter, as with fat saturated MRI. With conventional MRI, 18 endometrial implant lesions < 10mm in diameter were detected. Including those detected by fat saturated MRI, altogether 42 lesions were detected. Conventional MRI demonstrated only 3 lesions among the 48 blueberry spots, but the additional fat saturated MRI technique increased the detection rate to 21 out of 48. Fat saturated MRI can therefore be used for detecting small endometrial implants.