Transvaginal sonography vs uro-colon-CT in the diagnosis of deep infiltrating endometriosis of the anterior and posterior compartment

Pelvis, Colon, Urinary Tract / Bladder, CT, Ultrasound, Diagnostic procedure, Tissue characterisation Authors: D. Papadopoulos, F. Coppola, D. Valerio, C. Balacchi, L. Zannoni, S. Del Forno, R. Seracchioli, R. Golfieri; Bologna/IT DOI: 10.1594/ecr2015/B-0587 Purpose Deep infiltrating endometriosis (DIE) is defined by the presence of endometrial glands and stroma penetrating the retroperitoneal space to a depth of at least 5 mm. The mostly affected anatomical site is the pelvis, where DIE can involve structures of both the anterior and the posterior compartment. In order to mark the distinction between urinary and gastrointestinal involvement, we considered ureters as part of the anterior compartment (along with the bladder) and rectovaginal septum, rectum, sigmoid and rectosigmoid junction as part of the posterior compartment...

and materials We retrospectively analyzed 47 patients, selected on the basis of gynaecological examination, with clinical suspicion of aDIE and/or pDIE, who underwent TVS during gynecological examination and with indication to undergo U-CTC before laparoscopic surgery. TVSswereperformedby two gynecologists of the Center Of Chronic Pelvic Pain and Endometriosis, using a GE Voluson S8 ultrasound system(GE Medical Systems, Zipf, Austria). U-CTCs were performed using a 64 slice CT scanner (64 Lightspeed VCT, GE Healthcare, Milwaukee, WI, US) with the following protocol: detector collimation 64 x 0.625 mm, rotation...

The pathologic examination revealed localizations of pDIE in 41/47 women and aDIE in 39/47 women. TVS showed higher overall accuracy and sensitivity in diagnosing pDIE [Fig. 1 Fig. 2] (sensitivity, specificity and accuracy respectively 98%, 33% and 89% for TVS and71%, 50% and 68 % for U-CCT). Sensitivity in detecting aDIE [Fig. 3] was slightly higher for TVS while specificity and accuracy were almost comparable for both techniques (sensitivity, specificity and accuracy respectively 46%, 96% and 78% for TVS and38%, 96% and 75% for U-CCT)....

TVS,performed by specialists inendometriosis, is considered the gold standard technique for patients with symptoms ofDIE,due to its better accuracyif compared withU-CTC. This result could be partly explained by the fact that specialists in endometriosis can more easily complement ultrasonographic findings with anamnestic data, pain scale scores and clinical examinations. U-CTCshould be indicated only for selected patients, who presentnodules that result to bemore difficult todetect with TVS, like localizations involving the sigmoid colon, the rectosigmoid junction, the ureters and the bladder dome. Personal information Dr. Dimitris Papadopoulos Radiology Resident Alma Mater Studiorum, Bologna University Department of Diagnostic and Prevention Medicine Sant'Orsola-Malpighi Hospital Via Massarenti, 9 40138 Bologna, Italy Dr Francesca Coppola Consultant Radiologist Malpighi Radiology Unit, Department of Diagnostic and Prevention Medicine Sant'Orsola-Malpighi Hospital 15, Albertoni Street, 40138 Bologna, Italy

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