Diffusion tensor imaging and tractography to evaluate sacral nerve root abnormalities in endometriosis-related pain: A pilot study

L Manganaro, Lucia Manganaro, M G Porpora, Maria Grazia Porpora, V Vinci, Valeria Vinci, Silvia Bernardo, S Bernardo, P Lodise, Pietro Lodise, Paolo Sollazzo, P Sollazzo, Maria Eleonora Sergi, M E Sergi, Matteo Saldari, M Saldari, G Pace, Gianvito Pace, G Vittori, Giorgio Vittori, Carlo Catalano, C Catalano, P Pantano, Patrizià Pantano
European radiology · 2013 · vol. 24(1) , pp. 95–101 · doi:10.1007/s00330-013-2981-0 · PMID:23982288 · W2024947563
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⚙ AI-generated summary by claude@2026-06+body, 2026-06-09 ⓘ

Diffusion tensor imaging and tractography revealed sacral nerve root microstructural abnormalities in women with endometriosis-related pain, showing lower fractional anisotropy values compared to healthy controls.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-10 · read from full text ⓘ

This prospective pilot study evaluated microstructural abnormalities in sacral nerve roots in 30 women with ultrasound-diagnosed endometriosis and moderate-to-severe chronic pelvic pain, compared with 10 age-matched healthy controls, using 3T diffusion tensor imaging with post-processing tractography and quantifying fractional anisotropy (FA) in S1–S3. The paper reports that most patients showed bilaterally irregular, disorganized sacral root appearances on tractography and significantly lower FA values in S1, S2, and S3 than in controls, with no significant interobserver differences between two radiologists. As a pilot study, the limitations include the small sample size and the use of FA/tractography measures rather than direct confirmation of nerve pathology. This paper is centrally about endometriosis — it directly images and quantifies sacral nerve root microarchitecture abnormalities associated with endometriosis-related pain.

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Abstract

Objective To prospectively evaluate microstructural abnormalities in sacral nerve roots in women affected by chronic pelvic pain associated with endometriosis.

Methods

We enrolled 30 women with an ultrasound diagnosis of endometriosis and moderate-severe chronic pelvic pain; 10 age-matched healthy women comprised the control group. All subjects underwent 3 T magnetic resonance imaging (MRI), including diffusion tensor imaging (DTI); the sacral roots were reconstructed by post-processing the DTI data with dedicated software. Mean fractional anisotropy (FA) values in the S1, S2 and S3 roots were quantified. Analysis of FA values was performed by two radiologists in order to evaluate the interobserver agreement.

Results

The sacral nerve roots in healthy subjects were clearly visualised. Most of the patients with endometriosis displayed abnormalities of S1, S2 and S3 bilaterally at tractography, including an irregular and disorganised appearance. FA values in the S1, S2 and S3 roots were significantly lower in patients than in controls (P < 0.0001, <0.05 and <0.02, respectively) for both observers. No significant difference was found between observers.

Conclusion

DTI with tractography is a non-invasive means of detecting changes in the microarchitecture of the sacral nerve roots. It can qualitatively and quantitatively reveal sacral root abnormalities in patients with endometriosis-associated pain. Key Points • MRI is increasingly used for endometriosis and chronic pelvic pain (CPP). • Magnetic resonance tractography can demonstrate microarchitectural abnormalities in sacral nerve roots. • Tractography shows altered microstructure of sacral roots affected by endometriosis and CPP. • S1–S3 fractional anisotropy values are lower in endometriosis than in healthy women. • Sacral nerve root alteration may explain the nature of endometriosis-related CPP. Similar content being viewed by others

References

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Acknowledgements

Parts of this article were presented in electronic poster form at ECR 2013: “Fibre tracking evaluation of sacral nervous pathways 3D architecture in women affected by endometriosis”. Author information Authors and Affiliations Corresponding author Rights and permissions About this article Cite this article Manganaro, L., Porpora, M.G., Vinci, V. et al. Diffusion tensor imaging and tractography to evaluate sacral nerve root abnormalities in endometriosis-related pain: A pilot study. Eur Radiol 24, 95–101 (2014). https://doi.org/10.1007/s00330-013-2981-0 Received: Revised: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s00330-013-2981-0

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Condition tags

mesh:D004715mesh:D017699endometriosis

MeSH descriptors

Chronic Pain Diffusion Tensor Imaging Endometriosis Pelvic Pain Spinal Nerve Roots Adolescent Adult Chronic Pain Chronic Pain Diffusion Tensor Imaging Endometriosis Endometriosis Female Follow-Up Studies Humans Image Processing, Computer-Assisted Pain Measurement Pelvic Pain Pelvic Pain Pilot Projects

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