Complementary roles of rectal magnetic resonance imaging and endoscopic ultrasound in the preoperative assessment of rectal deep endometriosis: a retrospective cohort

Wen Zhang, Zhang W, Zhang X, Xiaocui Zhang, Hong Zhang, Zhang H, Gao Y, Yuying Gao, Qi W, Wenxu Qi, Wang S, Sheng Wang, Wang G, Guangwei Wang
Journal of Minimally Invasive Gynecology · 2026 · doi:10.1016/j.jmig.2026.08.012 · PMID:42600681 · W7203490967
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This retrospective study evaluated 59 rectal deep endometriosis patients, finding that while both rectal MRI and endoscopic ultrasound have good diagnostic efficacy, their poor consistency necessitates using them as complementary tools for comprehensive preoperative assessment.

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Abstract

OBJECTIVE: To investigate the complementary roles of rectal magnetic resonance imaging and endoscopic ultrasound in the preoperative assessment of rectal deep endometriosis. DESIGN: Retrospective, cross-sectional study. SETTING: Shengjing Hospital of China Medical University. PATIENTS: 59 rectal DE patients between January 2020 and September 2025. All patients underwent preoperative EUS and enhanced rectal MRI examinations, followed by laparoscopic surgery and pathological examination, with complete surgical, pathological, and imaging data. INTERVENTIONS: Taking the findings of laparoscopic exploration and postoperative pathological results as the gold standard, the diagnostic efficacy of EUS or rectal MRI for rectal DE, as well as the coincidence rate and differences between the two examination methods in the key preoperative evaluation indicators of rectal DE were evaluated. MEASUREMENTS AND MAIN RESULTS: The results showed that both examination methods had good diagnostic efficacy for rectal DE. The key preoperative evaluation indicators included lesion size, lesion location, distance from the lowest edge of the lesion to the anal verge, infiltration depth, single/multiple lesions, and the presence of multiple organ involvement. For most indicators, there were statistically significant differences in the coincidence rates evaluated by the two methods, with poor consistency for the same indicator, and only moderate consistency was achieved in the evaluation of the lesion size. This indicates that the two examination methods have different focuses and information differences in the evaluation of these key indicators, suggesting that the complementarity of the two methods should be comprehensively considered in clinical applications. CONCLUSION: Rectal MRI and EUS are both important imaging tools for rectal DE, each with its own advantages. However, they should be used as complementary imaging tools, and may offer more comprehensive preoperative information to help select optimal surgical strategies for patients with rectal DE.

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