Should virtual colonoscopy be included in the pre-operative imaging work-up of patients with intestinal endometriosis: A prospective comparative evaluation.

Carla Da Costa
In: European Congress of Radiology, 2013, Vienne, Austria · 2013 · doi:10.1594/ecr2013/c-1338 · W2520351970
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This prospective study compared virtual colonoscopy with standard imaging for pre-operative evaluation of intestinal endometriosis, assessing its diagnostic accuracy and utility.

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This prospective comparative evaluation enrolled 77 patients with suspected intestinal endometriosis scheduled for surgery (2009–2012) and assessed whether virtual colonoscopy (VC) could diagnose and characterize intestinal involvement, compared with magnetic resonance imaging (MRI) and endorectal ultrasonography (ERS). Using light bowel preparation and CT-based VC on a 64-multidetector scanner, the study found that pathological analysis confirmed intestinal endometriosis in 73/77 cases, with VC showing overall sensitivity of 97.3% for intestinal involvement, significantly higher than MRI (83.2%, p=0.002) and not significantly different from ERS (89.7%, p=0.07). The authors report that VC additionally provided information on rectal stenosis type, potentially addressing locations not accessible to ERS, with MRI described as a gold standard for gynecological involvements, though lesion characterization details and comparative sensibilities for specific segments were only partially presented in the abstract. This paper is centrally about endometriosis — it evaluates CT virtual colonoscopy as pre-operative imaging for intestinal endometriosis and compares its diagnostic performance with MRI and ERS.

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Abstract

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Keywords

Gastrointestinal tract, Genital / Reproductive system female, CT, Colonography CT, Obstruction / Occlusion Authors: C. Da Costa1, H. Roman2, J. van der Wat3, M. Vassilief2, J.-J. Tuech2, C. Martin2, J.-N. Dacher2, C. Savoye-Collet2; 1Le Chesnay/FR, 2Rouen/FR, 3Johannesburg/ZA DOI: 10.1594/ecr2013/C-1338 Purpose Management of patients with severe intestinal endometriosis remains a therapeutic challenge, which eventually needs surgery. On one hand, surgical treatment planning requires both precise preoperative location of endometriosis lesions and assessment of intestinal wall or lumen involvements. On the other hand, none of the imaging modalities currently available in the preoperative workup of patients with severe intestinal endometriosis such as endorectal ultrasonography (ERS) and magnetic resonance imaging (MRI) provides complete and accurate evaluation of these features. Virtual colonoscopy (VC), which is routinely used in the...

Methods

and Materials Patient selection Between 2009 and 2012, 77 patients with suspected intestinal endometriosis qualifying for surgery were prospectively enrolled to assess the existence and characterize the type of intestinal involvement on VC. Of these, 75 (97.4%) and 72 (93.5%) had already undergone associated MRI and endorectal ultrasonography (ERS) respectively. VC preparation and technique The day before the examination, all patients received a light colonic preparation to ensure adequate intestinal cleansing. The examination started with limited pressure carbon dioxide insufflation. Scans were performed on a 64-multidetector CT...

Results

Pathological analysis confirmed the diagnosis of intestinal endometriosis in 73 (95%) cases. Rectal, sigmoid, transverse colon, caecal and ileal involvements were observed in 70 (96%), 32 (4%), 2 (3%), 5 (7%) and 6 (8%) cases respectively (Figures 6-19). Overall sensibility of VC for the diagnosis of intestinal involvement was 97.3% and was significantly higher compared to MRI (83.2%, p=0.002), but not significantly different from ERS (89.7%, p=0.07). Sensibilities for the diagnosis of rectal, sigmoid, transverse colon, caecal and ileal wall involvements using VC were 83%,...

Conclusion

In this prospective series, virtual colonoscopy displayed at least similar sensitivity as ERS and MRI in the assessment of intestinal involvement and therfore yields high diagnostic performance in the pre-operative evaluation of patients with intestinal endometriosis. While MRI remains the gold standard in the evaluation of gynecological involvements, VC allows additionnal assessment of several intestinal locations, which are not accessible to ERS, but also brings valuable information regarding the existence and type of rectal stenosis. In that sense, VC clearly challenges ERS in the standard...

References

1. van der Wat J, Kaplan MD. Modified virtual colonoscopy: a noninvasive technique for the diagnosis of rectovaginal septum and deep infiltrating pelvic endometriosis. J Minim Invasive Gynecol. 2007 Sep-Oct;14(5):638-43. 2. Vassilieff M, Suaud O, Collet-Savoye C, Da Costa C, Marouteau-Pasquier N, Belhiba H, Tuech JJ, Marpeau L, Roman H. Computed tomography-based virtual colonoscopy: an examination useful for the choice of the surgical management of colorectal endometriosis. Gynecol Obstet Fertil. 2011 Jun;39:339-45.

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endometriosis

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