Correlation between MR semiotics and intensity of pelvic pain syndrome in female patients with deep infiltrating endometriosis of the posterior pelvic compartment

K. D. Marchenko, A. G. Gramatikova, О. В. Лукина, V. F. Bezhenar, E. V. Bubnova
In: Regional blood circulation and microcirculation · 2024 · vol. 23(1) , pp. 44–49 · doi:10.24884/1682-6655-2024-23-1-44-49 · W4394603094
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This study found that deep infiltrating endometriosis of the posterior pelvic compartment, especially with intestinal wall invasion, correlates with more intense pelvic pain in female patients.

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The paper investigated the relationship between MRI semiotic findings and pelvic pain intensity in 77 women aged 24–39 years with pelvic pain, using retrospective and prospective analysis of pelvic MRI. Pain intensity was assessed with a visual analog scale (VAS) and patients were grouped by involvement of the posterior pelvic compartment in presumed external genital endometriosis, with further subdivision based on MRI signs of suspected bowel wall invasion (rectal/adjacent thick bowel segments). Women with posterior compartment endometriosis without MRI evidence of bowel wall invasion had higher VAS pain than women without posterior compartment involvement, and those with MRI signs of bowel wall invasion had significantly higher pain than those without such signs (VAS 8.0 vs 7.0; both P<0.001). The authors’ caveat is that the conclusions are framed around MRI findings and their association with pain rather than confirmed invasion, and they emphasize careful posterior pelvic assessment to avoid complications, though the study design details beyond the high-level retrospective/prospective analysis are limited. This paper is centrally about endometriosis — it specifically correlates MRI findings in deep infiltrating/presumed bowel-involving posterior compartment endometriosis with pelvic pain intensity.

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Abstract

Objective . To identify the correlation between magnetic resonance (MR) semiotics and the intensity of pelvic pain syndrome in female patients with deep infiltrating endometriosis of the posterior pelvic compartment. Material and methods . We performed a retro- and prospective analysis of MR studies of pelvic organs in 77 female patients with pelvic pain syndrome, aged from 24 to 39 years. We assessed the intensity of the pain syndrome using a visual analog scale (VAS). The patients were divided into 2 groups: 1st-patients with external genital endometriosis (EGE) without involving the posterior pelvic compartment, 2nd-patients with EGE of the posterior pelvic compartment. The patients of the second group were divided into subgroups: 1 – endometriosis of the posterior pelvic compartment without MR signs of intestinal wall invasion, 2 – posterior compartment endometriosis with MR signs of intestinal wall invasion. The study was conducted on a GE Signa 1.5 Tesla MRI scanner. Results. In the second group of patients with endometriosis of the posterior pelvic compartment, the pain syndrome (8.00 (7.00–9.00) was more intense than in the first group of patients without endometriosis of the posterior pelvic compartment 7.00 (5.00–7.00), p<0.001 and we evaluated a retrovaginal, retrocervical and posterior uterine localization. In the second subgroup of patients with signs of the intestinal wall invasion, the pelvic pain syndrome on the VAS was statistically significantly more intense 8.00 (8.00-10.00) than in the first subgroup of patients without signs of the intestinal wall invasion 7.00 (6.00–7.00) (P<0.001). Conclusion . Patients with identified deep infiltrating endometriosis of the posterior pelvic compartment have more pronounced manifestations of the pelvic pain syndrome then patients with endometriosis of other localizations.
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Взаимосвязь МР-семиотики и интенсивности синдрома тазовых болей у пациенток с глубоким инфильтративным эндометриозом заднего компартмента малого таза https://doi.org/10.24884/1682-6655-2024-23-1-44-49 Аннотация Цель. Выявить взаимосвязь между МР-семиотикой и интенсивностью синдрома тазовых болей у пациенток с глубоким инфильтративным эндометриозом заднего компартмента малого таза. Материал и методы. Проведен ретро- и проспективный анализ МР-исследований органов малого таза у 77 пациенток с синдромом тазовых болей, возраст от 24 до 39 лет. Интенсивность болевого синдрома оценивалась по визуально-аналоговой шкале (ВАШ). Пациентки были поделены на 2 группы: 1) пациентки с наружным генитальным эндометриозом (НГЭ), не вовлекающим задние отделы малого таза; 2) пациентки с НГЭ заднего отдела малого таза. Пациентки второй группы были разделены на подгруппы: 1 – эндометриоз заднего компартмента малого таза без МР-признаков инвазии стенки кишки, 2 – эндометриоз заднего компартмента c МР-признаками инвазии стенки прилежащих отделов толстой кишки. Исследование проводилось на МР-томографе GE Signa 1,5 Тесла. Результаты. Во второй группе пациенток с эндометриозом заднего компартмента малого таза болевой синдром (8,00 (7,00–9,00) был более интенсивным, чем в первой группе пациенток без эндометриоза заднего компартмента 7,00 (5,00–7,00), р<0,001, оценивались ретровагинальная, ретроцервикальная и позадиматочная локализации. Во второй подгруппе пациенток с признаками инвазии стенки прилежащих отделов толстой кишки синдром тазовых болей по шкале ВАШ был статистически значимо более интенсивным 8,00 (8,00–10,00), чем в первой подгруппе пациенток без признаков инвазии стенки прилежащих отделов толстой кишки 7,00 (6,00–7,00) (P<0,001). Заключение. МР-диагностика органов малого таза у пациенток с выраженным болевым синдромом должна проводиться с усиленным вниманием на задние отделы малого таза во избежание осложнений эндометриоза. Оценка вовлечения стенки толстой кишки в процесс НГЭ также имеет значение не только для планирования хирургического лечения, но и для выявления причин интенсивного болевого синдрома у пациенток. Об авторах К. Д. МарченкоРоссия Марченко Ксения Дмитриевна – аспирант кафедры рентгенологии и радиационной медицины, врач-рентгенолог 197022, Санкт-Петербург, ул. Льва Толстого, д. 6-8 А. Г. Граматикова Россия Граматикова Ана Гурамовна – аспирант кафедры акушерства, гинекологии и неонатологии, врач-гинеколог 197022, Санкт-Петербург, ул. Льва Толстого, д. 6-8 О. В. Лукина Россия Лукина Ольга Васильевна – д-р мед. наук, доцент кафедры рентгенологии и радиационной медицины 197022, Санкт-Петербург, ул. Льва Толстого, д. 6-8 В. Ф. Беженарь Россия Беженарь Виталий Федорович – д-р мед. наук, профессор, зав. кафедры акушерства, гинекологии и неонатологии 197022, Санкт-Петербург, ул. Льва Толстого, д. 6-8 Е. В. Бубнова Россия Бубнова Евгения Викторовна – канд. мед. наук, доцент кафедры рентгенологии и радиационной медицины 197022, Санкт-Петербург, ул. Льва Толстого, д. 6-8 Список литературы 1. Российское общество акушеров-гинекологов. Клинические рекомендации. Эндометриоз. – М.: Министерство здравоохранения РФ, 2020. – С. 10–11. [Russian Society of Obstetricians and Gynecologists. Сlinical recommendations. Enndometryosis. Moscow, Ministerstvo zdravoohranenija RF, 2020:10-11. (In Russ.)]. 2. Guerriero S, Alcázar, JL, Pascual MA, Ajossa S, Perniciano M, Piras A, Saba L. Deep Infiltrating Endometriosis: Comparison Between 2-Dimensional Ultrasonography (US), 3-Dimensional US, and Magnetic Resonance Imaging. J Ultrasound Med. 2017;37(6):1511-1521. Doi: 10.1002/jum.14496. 3. Адамян Л.В., Азнавурова Я.Б. Молекулярные аспекты патогенеза эндометриоза // Проблемы репродукции. – 2015. – Т. 21, № 2. – С. 66–77. [Adamyan LV, Aznavurova YaB. Molecular aspects of the pathogenesis of endometriosis. Russ J Human Reproduction. 2015;21(2):66-77. (In Russ.)]. Doi: 10.17116/repro201521266-77. 4. Adamson GD, Kennedy S, Hummelshoj L. Creating Solutions in Endometriosis: Global Collaboration through the World Endometriosis Research Foundation. J Endometriosis. 2010;(2-1):3-6. Doi: 10.1177/228402651000200102. 5. Jha P, Sakala M, Chamie LP, Feldman M, Hindman N, Huang C, Taffel MT. Endometriosis MRI lexicon: consensus statement from the society of abdominal radiology endometriosis disease-focused panel. Abdom Radiol (NY). 2020;(6):1552-1568. Doi: 10.1007/s00261-019-02291-x. 6. Abesadze E, Chiantera V, Sehouli J, Mechsner S. Post-operative management and follow-up of surgical treatment in the case of rectovaginal and retrocervical endometriosis. Arch Gynecol Obstet. 2020;(4):957-967. 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Complete surgery for low rectal endometriosis: long-term results of a 100-case prospective study. Ann Surg. 2010; 251(5):887-895. Doi: 10.1097/SLA.0b013e3181d9722d. 12. Burla L, Scheiner D, Hötker AM, Meier A, Fink D, Boss A, Imesch P. Structured manual for MRI assessment of deep infiltrating endometriosis using the ENZIAN classification. Arch Gynecol Obstet. 2020;(3):751-757. Doi: 10.1007/s00404-020-05892-w. 13. Miller EJ, Fraser IS. The importance of pelvic nerve fibers in endometriosis. Womens Health (Lond). 2015;11(5):611-618. Doi: 10.2217/whe.15.47. 14. Barbisan CC, Andres MP, Torres LR, Libânio BB, Torres US, D’Ippolito G, Abrao MS. Structured MRI reporting increases completeness of radiological reports and requesting physicians’ satisfaction in the diagnostic workup for pelvic endometriosis. Abdom Radiol (NY). 2021;46(7):3342-3353. Doi: 10.1007/s00261-021-02966-4. 15. Thalluri AL, Knox S Nguyen T. MRI findings in deep infiltrating endometriosis: A pictorial essay. J Med Imaging Radiat Oncol. 2017;61(6):767-773. Doi: 10.1111/1754-9485.12680. 16. Giudice LC. Clinical practice: endometriosis. N Engl J Med. 2010;362(25):2389-2398. Doi: 10.1056/NEJMcp1000274. Рецензия Для цитирования: Марченко К.Д., Граматикова А.Г., Лукина О.В., Беженарь В.Ф., Бубнова Е.В. Взаимосвязь МР-семиотики и интенсивности синдрома тазовых болей у пациенток с глубоким инфильтративным эндометриозом заднего компартмента малого таза. Регионарное кровообращение и микроциркуляция. 2024;23(1):44-49. https://doi.org/10.24884/1682-6655-2024-23-1-44-49 For citation: Marchenko K.D., Gramatikova A.G., Lukina O.V., Bezhenar V.F., Bubnova E.V. Correlation between MR semiotics and intensity of pelvic pain syndrome in female patients with deep infiltrating endometriosis of the posterior pelvic compartment. Regional blood circulation and microcirculation. 2024;23(1):44-49. (In Russ.) https://doi.org/10.24884/1682-6655-2024-23-1-44-49 JATS XML

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