EP24.11: How can diffusion and T2 star weighted magnetic resonance Imaging aid in the diagnosis of ectopic endometrium?

To evaluate the performance of magnetic resonance imaging (MRI) with T2* and diffusion weighted imaging (DWI) in the diagnosis of ectopic endometrial implantation. MRI was done for 60 patients with 66 lesions diagnosed or suspected by ultrasonography to have endometriosis. The MRI was conducted with a 1.5-T magnet. MRI protocol included T1W, with and without fat-saturation sequences, T2W, DWI and T2* weighted imaging. MRI results were correlated with histopathological findings received through in laparoscopy, laparotomy or open surgical resection. 66 pathologically proven lesions were identified as follows: 34 Ovarian Endometriomas, 8 Abdominal wall Caesarean scar endometriosis, 2 bladder endometriosis, 8 adenomyosis and 14 non-endometriotic/hemorrhagic cysts. 32 out 52 cases showed typical appearance on conventional MRI while 42 out of 52 cases; showed diffusion restriction and 50 out 52 cases showed signal voids at T2 star weighted MRI images. Endometriotic lesions that showed diffusion restriction on DWI were 80.7%, and 96.1% of the endometriotic lesions had signal voids on the T2*W sequence, whereas only 65.4% of the lesions had typical signal intensities on T1WI and T2WI. Diagnostic performance of the MRI examination was improved by the use of the diffusion sequence and better improved by the T2* sequence, compared to the conventional MR protocol sensitivity (SE) = 96.12% and specificity (SP) = 85.7% in T2* weighted images; SE = 80.7% and SP = 71.4 % in DWI; SE = 65.4% and SP = 71.4% in conventional MRI. P value for conventional MRI was 0.1, which is of no statistical significance (p < 0.05). P value for DWI was 0.016, which is statistically significant (p < 0.05).P value for T2*WI was 0.001, which is more statistically significant (p < 0.05) and could be adequately correlated with laparoscopy. DWI and T2* significantly increases MRI diagnostic accuracy by allowing the detection of hemorrhagic character of the endometriotic lesions.