Deep pelvic endometriosis: accuracy of pelvic MRI completed by MR colonography

Purpose This study assessed the diagnostic accuracy of pelvic magnetic resonance (MR) imaging completed by MR colonography for the preoperative evaluation of deep pelvic endometriosis in patients undergoing laparoscopic surgery.

A total of 143 patients (mean age 34.3±5.1 years) with a clinical suspicion of deep pelvic endometriosis were assessed by pelvic MR and MR colonography. All patients underwent laparoscopic surgery 3–10 weeks after the MR examination. The presence, location, number and extent of endometriotic lesions were evaluated. Data obtained with MR were compared with surgical findings. MR sensitivity, specificity, positive (PPV) and negative (NPV) predictive values and diagnostic accuracy values were calculated for each site by considering the laparoscopic and histological findings as the reference standard.

Laparoscopy confirmed the presence of endometriosis in 119/143 patients (83%); in 76/119 (64%) deep pelvic endometriosis was diagnosed, whereas in the remaining 43/119 (36%), superficial peritoneal implants and endometriomas were found. In 32/119 (27%) patients, intestinal lesions were detected. MR had sensitivity, specificity, PPV, NPV and diagnostic accuracy values of 67–100%, 85–100%, 83–100%, 84–100% and 84–100%, respectively, in recognising lesions located in different pelvic sites. Conslucions MR imaging combined with colonography is a highly accurate tool for characterising deep endometriotic lesions in patients scheduled for laparoscopic surgery. In particular, MR colonography has very high accuracy in detecting colorectal involvement. Riassunto Obiettivo Scopo del presente lavoro è stato valutare l’accuratezza diagnostica della risonanza magnetica (RM) pelvica associata a colonografia-RM nella valutazione preoperatoria della endometriosi pelvica profonda in pazienti sottoposte ad intervento per via laparoscopica. Materiali e metodi Centoquarantatre pazienti (età media 34,3±5,1 anni) con sospetto clinico di endometriosi pelvica profonda sono state valutate mediante RM pelvica completata con colonografia-RM. Tutte le pazienti sono state sottoposte a laparoscopia con un intervallo di 3–10 settimane dall’esame RM. Sono stati valutati presenza, sede, numero ed estensione delle lesioni endometriosiche. I dati ottenuti dalla RM sono stati confrontati con quelli chirurgici. Sensibilità, specificità, valore predittivo positivo (VPP) e negativo (VPN) ed accuratezza diagnostica della RM sono stati calcolati per ciascuna sede esaminata, considerando i reperti laparoscopici e istologici quale gold standard. Risultati La laparoscopia ha confermato la presenza di endometriosi in 119/143 pazienti (83%); in 76/119 (64%) era evidente endometriosi pelvica profonda, mentre nelle rimanenti 43/119 (36%) erano presenti endometriomi e impianti peritoneali superficiali. In 32/119 (27%) pazienti, sono state riscontrate lesioni intestinali. La RM ha presentato valori di sensibilità, specificità, VPP, VPN e accuratezza diagnostica rispettivamente compresi tra 67%–100%, 85%–100%, 83%–100%, 84%–100%, 84%–100% nel riconoscimento delle diverse sedi di impianto della patologia. Conclusioni La RM associata a colonografia rappresenta una metodica accurata per lo studio delle pazienti con endometriosi pelvica profonda da sottoporre ad intervento chirurgico laparoscopico e per la caratterizzazione delle lesioni endometriosiche. In particolare la colonografia-RM consente elevati valori di accuratezza nell’identificazione delle lesioni intestinali. 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