An Optimized Procedure for Non-Contrast Magnetic Resonance Imaging in the Diagnosis of Chronic Pelvic Pain in Women

K. A. Zavylova, B Shakhov, S. V. Morovov
In: Journal of radiology and nuclear medicine · 2020 · vol. 101(2) , pp. 103–112 · doi:10.20862/0042-4676-2020-101-2-103-112 · W3024399315
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A modified non-contrast MRI protocol for the pelvis demonstrated significantly higher sensitivity and specificity for diagnosing gynecological and extragenital factors contributing to chronic pelvic pain in women compared to a standard protocol.

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The paper studied whether an optimized non-contrast MRI protocol of the pelvis and lower abdominal regions improves diagnostic performance for chronic pelvic pain in women, compared with a standard pelvic MRI protocol. In 57 reproductive-age women with chronic pelvic pain, all underwent ultrasound first, then MRI with both standard and modified protocols, with final diagnoses established using a comprehensive workup that included clinical-neurologic and gynecologic exams plus additional imaging and, when indicated, endoscopy and laparoscopy with morphological/histological evaluation. The modified protocol showed very high diagnostic accuracy versus the standard protocol, with sensitivity 99.2% (95% CI 97.6–100%) and specificity 99.6% (95% CI 99.5–100%), and the authors note that the MRI time and equipment/software requirements were not increased. Relevance to endometriosis: the introduction and discussion situate pelvic MRI within the broader context of pelvic pain and cite prior MRI guidance and studies for pelvic endometriosis, though this paper’s primary objective is optimizing a general non-contrast MRI protocol for chronic pelvic pain rather than specifically diagnosing endometriosis.

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Abstract

Objective . To optimize a pelvic and lower abdominal cavity MRI protocol in the diagnosis of chronic pelvic pain (CPP) in women. Material and methods . A total of 57 reproductive-aged women with complaints of CPP were examined. The first stage of all patients after clinical and laboratory examination for clinical indications was performed ultrasound of the pelvis and abdominal cavity with dopplerometry. In the second stage, all the patients underwent an MRI using the standard Protocol, and then a modified Protocol. The final diagnosis was based on the results of a comprehensive examination, which included a clinical and neurological examination, gynecological examination, pelvic and abdominal ultrasound, radiography of the ileosacral joints and lumbosacral spine, fibrocolonoscopy and laparoscopy with morphological examination of the operating material (according to indications). Results . Forty-six (81%) patients were found to have gynecological factors for the development of CPP; 16 (28%) had extragenital factors. The examination results were verified by the data of surgical intervention (n = 16 (28%)), hysteroscopy (n = 21 (37%)), and laparoscopy (n = 9 (16%)) with morphological examination of biopsy specimens or surgical material.Comparing with the standard pelvic MR protocol provided evidence for the high diagnostic value of the modified protocol statistically significantly (p < 0.05): 99.2% sensitivity and 99.6% specificity. Conclusion . The developed non-contrast 1.5T MRI protocol for the pelvis permits MR images of the pelvis and adjacent anatomical areas to be obtained during one study without increasing time expenditures and upgrading equipment and software. The use of the protocol makes it possible to improve the quality of radiation diagnosis of gynecological and extragenital diseases in CPP and to recommend that the protocol in combination with other clinical and instrumental studies be introduced in clinical practice.
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Оптимизированная методика бесконтрастной магнитно-резонансной томографии в диагностике хронических тазовых болей у женщин https://doi.org/10.20862/0042-4676-2020-101-2-103-112 Аннотация Цель исследования – оптимизация протокола магнитно-резонансной томографии (МРТ) малого таза и нижнего этажа брюшной полости в диагностике хронических тазовых болей у женщин. Материал и методы. Обследованы 57 женщин репродуктивного возраста с жалобами на хроническую тазовую боль (ХТБ). Первым этапом всем пациенткам после клинико-лабораторного обследования по клиническим показаниям выполнено УЗИ малого таза и брюшной полости с допплерометрией. Вторым этапом всем пациенткам была проведена МРТ по стандартному, а затем по модифицированному протоколу. Окончательный диагноз устанавливали на основании результатов комплексного обследования, которое включало клинико-неврологическое обследование, гинекологический осмотр, УЗИ малого таза и брюшной полости, рентгенографию илеосакральных сочленений и пояснично-крестцового отдела позвоночника, фиброколоноскопию и лапароскопию с морфологическим исследованием операционного материала (по показаниям). Результаты. У 46 (81%) пациенток выявлены гинекологические факторы развития ХТБ, у 16 (28%) экстрагенитальные факторы. Результаты обследования верифицированы данными оперативного вмешательства у 16 (28%), гистероскопии – у 21 (37%), лапароскопии – у 9 (16%) больных с морфологическим исследованием биоптатов или операционного материала. При сравнении со стандартным МР-протоколом малого таза статистически достоверно (р < 0,05) доказана высокая диагностическая ценность модифицированного протокола: чувствительность – 99,2% (ДИ 97,6–100%), специфичность – 99,6% (ДИ 99,5–100%). Заключение. Разработанный протокол бесконтрастной МРТ малого таза для 1,5 Т томографа дает возможность получать в рамках одного исследования МР-изображения малого таза и смежных анатомических областей без увеличения временных затрат, модернизации оборудования и программного обеспечения. Использование протокола позволяет повысить качество лучевой диагностики гинекологической и экстрагенитальной патологии при ХТБ и рекомендовать его для внедрения в клиническую практику в комплексе с другими методами клинико-инструментального обследования. Об авторах К. А. ЗавыловаРоссия Завылова Ксения Александровна, аспирант, врач-рентгенолог пл. Минина и Пожарского, 10/1, Нижний Новгород, 603005 ул. Советская, 12, Нижний Новгород, 603002 Б. Е. Шахов Россия Шахов Борис Евгеньевич, д. м. н., профессор, заведующий кафедрой лучевой диагностики, интервенционной и сердечно-сосудистой хирургии пл. Минина и Пожарского, 10/1, Нижний Новгород, 603005 С. В. Моровов Россия Моровов Сергей Викторович, заведующий Консультативно-диагностическим центром ул. Советская, 12, Нижний Новгород, 603002 ул. Ванеева, 211, Нижний Новгород, 603136 Список литературы 1. Speer L.M., Mushkbar S., Erbele T. Chronic pelvic pain in women. Am. Fam. Physician. 2016; 93 (5): 380–7. 2. Chronic pelvic pain in women (2018). Available at: http://www.mayoclinic.org/symptoms/pelvic-pain/basics/definition/sym-20050898 (accessed May 1, 2019). 3. Khan K.S., Tryposkiadis K., Tirlapur S.A., Middleton L.J., Sutton A.J., Priest L. et al. MRI versus laparoscopy to diagnose the main causes of chronic pelvic pain in women: a testaccuracy study and economic evaluation. Health Technol. Assess. 2018; 22 (40): 1–92. DOI: 10.3310/hta22400 4. Wozniak S. Chronic pelvic pain. Ann. Agric. Environ. Med. 2016; 23 (2): 223–6. DOI: 10.5604/12321966.1203880 5. Безнощенко Г.Б., Московенко Н.В., Кравченко Е.Н., Кропмаер К.П., Цыганкова О.Ю., Безнощенко А.Б. и др. 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DOI: 10.1259/bjr.20160512 Рецензия Для цитирования: Завылова К.А., Шахов Б.Е., Моровов С.В. Оптимизированная методика бесконтрастной магнитно-резонансной томографии в диагностике хронических тазовых болей у женщин. Вестник рентгенологии и радиологии. 2020;101(2):103-112. https://doi.org/10.20862/0042-4676-2020-101-2-103-112 For citation: Zavylova K.A., Shakhov B.E., Morovov S.V. An Optimized Procedure for Non-Contrast Magnetic Resonance Imaging in the Diagnosis of Chronic Pelvic Pain in Women. Journal of radiology and nuclear medicine. 2020;101(2):103-112. (In Russ.) https://doi.org/10.20862/0042-4676-2020-101-2-103-112 JATS XML Это произведение доступно по лицензии Creative Commons «Attribution-NonCommercial» («Атрибуция — Некоммерческое использование») 3.0 Непортированная

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