Deep pelvic endometriosis: MR imaging with laparoscopic and histologic correlation

Authors: S. Gispert; Barcelona/ES DOI: 10.1594/ecr2012/C-0372 Purpose Deep pelvic endometriosis is defined as subperitoneal infiltration of the endometrial implants in the uterosacral ligaments, rectum, rectovaginal septum, vagina or bladder. Accurate preoperative assessment of deep pelvic endometriosis is required for planning complete surgical excision, but such assessment is difficult with physical examination, ultrasound, even with exploratory laparoscopy. Despite some limitations, magnetic resonance (MR) imaging is able to directly demonstrate deep pelvic endometriosis. The purpose of this retrospective study was to evaluate the accuracy of MR for the preoperative diagnosis and local staging of...

and Materials Among a large group of patients referred in our institution to MR study for pelvic endometriosis, we selected 18 patients with histologically confirmed deep pelvic endometriosis. We retrospectively evaluated those studies performed between January 2006 and October 2008 (overall duration 34 months) and compared with the laparoscopic results. The age of the patients ranged from 24 to 47 years (mean age 32). All patients underwent transvaginal ultrasound, MR, and laparoscopy. We also reviewed: - clinical symptoms - surgical history - performance of other imaging studies:...

The most frequent clinical symptom was pain. The patients also reported: - dysmenorrhoea (12/18) - tenesmus and/or pain on defaecation (7/18) - sterility (6/18) - chronic pelvic pain (5/18) - dyspareunia (5/18) - dysuria (2/18) Regarding previous surgical procedures some patient underwent: - adhesiolysis for previous adherences (4/18) - bilateral ovarian cystectomy for endometriomas (3/18) - ovariectomy and salpinguectomy for endometriosis (1/18) - subtotal histerectomy for adenomyosis (1/18) - appendicectomy (1/18) - cervical uterine conization (1/18) All the patients were evaluated by transvaginal ultrasound. An...

MR imaging is a useful modality as an adjunct to physical examination and transvaginal and transrectal sonography in evaluation of patients with deep infiltrating endometriosis. MR imaging demonstrates high accuracy (90% of success) in the detection of deep implants as well as their extension. All the information offered by MR imaging is useful in planning the best treatment, surgical or medical, for the disease. Therefore, in our opinion, MR imaging may be recommended in preoperative assessment of patients with deep pelvic endometriosis. MR imaging is...

C. Del Frate, R. Girometti, M. Pittino, G. Del Frate, M. Bazzocchi, C. Zuiani. Deep Retroperitoneal Pelvic Endometriosis: MR Imaging Appearance with Laparoscopic Correlation. RadioGraphics 2006;26:1705-1718. Bazot M, Darai E, Hourani R. et al. Radiology 2004 Aug;232(2):379-89.Deep pelvic endometriosis: MR imaging for diagnosis and prediction of extension of disease. Chapron C, Fauconnier A, Vieira M, et al. Anatomical distribution of deeply infiltrating endometriosis: surgical implications and proposition for a classification. Hum Reprod 2003; 18:157-161. Zanardi R, Del Frate C, Zuiani C, Del Frate G, Bazzocchi... Personal Information Dr. Susana Gispert Herrero Magnetic Resonance Unit - IDI, Vall d' Hebron Hospital (Barcelona,Spain) email: [email protected]