Deeply infiltrating endometriosis: Evaluation of retro-cervical space on MRI after vaginal opacification

Fiaschetti V, Valeria Fiaschetti, Crusco S, Sonia Crusco, Alessandro Meschini, Cama V, Valentina Cama, Di Vito L, Livio Di Vito, Massimiliano Marziali, Marziali M, Emilio Piccione, Ferdinando Calabria, Simonetti G, Giovanni Simonetti
European journal of radiology · 2011 · vol. 81(11) , pp. 3638–3645 · doi:10.1016/j.ejrad.2011.06.058 · PMID:21813257 · W2079782627
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This study evaluated the retro-cervical space on MRI after vaginal opacification to assess deeply infiltrating endometriosis.

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Abstract

ObjectivesTo prospectively investigate diagnostic value and tolerability of MRI after intra-vaginal gel opacification for diagnosis and preoperative assessment of deeply infiltrating endometriosis.MethodsSixty-three women with clinical suspicion of deeply infiltrating endometriosis were previously examined with trans-vaginal ultrasonography and then with MRI pre and post administration of vaginal gel. We evaluated the tolerability of this procedure with a scoring scale from 0 to 3. We also assessed with a score from 1 to 4 the visibility of four regions: Douglas-pouch, utero-sacral-ligaments, posterior-vaginal-fornix and recto-vaginal-septum. All patients underwent laparoscopic surgery after MRI.ResultsFive patients considered procedure intolerable. Visibility of utero-sacral-ligaments and posterior-vaginal-fornix showed to be increased with gel (p<0.001). In 57 out of 80 patients the MRI has allowed us to diagnose deeply infiltrating endometriosis. Overall, the percentages of MRI-sensitivity, specificity, positive predictive value and negative predictive value were respectively 67.8%, 95.3%, 89.4 and 83.5% without gel, and 90.8%, 94.6%, 90.8% and 94.6% with gel; trans-vaginal ultrasonography sensitivity, specificity, positive predictive value and negative predictive value were 57.5%, 96.6%, 90.9% and 79.5%. In evaluation of utero-sacral-ligaments trans-vaginal ultrasonography, MRI without gel and with gel sensitivity was respectively 61.9%, 47.6% and 81%; for recto-vaginal-septum these values were 12.5%, 68.7% and 93.7%; for pouch of Douglas 82%, 87% and 97.4%; finally for posterior-vaginal-fornix 27.3%, 36.4% and 81.8%.ConclusionsMRI with gel opacification of vagina should be recommended for suspicion of deep infiltrating endometriosis, in particular for the added value in evaluation of recto-vaginal septum, utero-sacral ligaments and posterior vaginal fornix.

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Image Enhancement Magnetic Resonance Imaging Subtraction Technique Vagina Vaginal Creams, Foams, and Jellies Adult Artifacts Endometriosis Female Humans Image Enhancement Magnetic Resonance Imaging Middle Aged Reproducibility of Results Sensitivity and Specificity Vagina

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