Merits of timing a woman’s menstrual cycle in performing an MRI to stage endometriosis

Pelvis, MR, Screening, Outcomes Authors: S. McElroy, A. Ajjikuttira DOI: 10.26044/ranzcr2023/C-277 Learning objectives We undertook a review of the literature to assess if timing an endometriosis staging MRI examination to the patient’s menstrual cycle improves diagnosis. Secondary aims of the review were to collate information on MRI findings typically seen when imaging endometriosis.

Endometriosis is a chronic inflammatory disease affecting 10% of women of reproductive age. It leads to subfertility and pelvic pain. Currently, the gold standard diagnostic test is laparoscopy, which is expensive and carries surgical risks. MRI is now more commonly performed in suspected cases of endometriosis for preoperative planning.1 Oestrogen is the main hormone responsible for the growth and persistence of endometrial deposits as well as the pain and inflammation associated with it. Oestrogen levels are highest around day 14 of the menstrual cycle and... Imaging findings OR Procedure details On T2 weighted MRI images, solid endometriotic lesions appear as hypointense nodular structures with irregular margins due to fibrous tissue and smooth muscle proliferation.(Figure 1-2) Endometrial tissue responds to oestrogen during each menstrual cycle through stimulating a cyclic haemorrhage that induces a considerable inflammatory response and fibrous reaction - thereby increasing the size and weight of the endometriotic lesions.3-4 Conflicting literature exists regarding timing MRI with a woman’s menstrual cycle for endometriosis diagnosis. Studies suggest thatsensitivityof MRI improves when a woman has higher levels of...

MRI has the potential to become the main imaging modality for endometriosis and become a new gold standard instead of laparoscopy.9 Hormonal stimulation may affect sensitivity and specificity of MRI for diagnosing endometriosis, however the evidence base in this field is small. Consequently, further studies are required to inform recommendations for this practice.

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