OC02.07: Could adenomyosis be considered as a marker of severity in intestinal endometriosis?

Adenomyosis is defined as a benign invasion of the endometrium into the myometrium. Magnetic Resonance Imaging enables the diagnosis, by measuring the thickness of a distinct low-intensity myometrial band on T2- weighted images, called Junctional Zona (JZ). The extent of adenomyosis can be diffuse or focal lesions, involving the uterine wall. The objective is to determine the correlation between adenomyosis and the severity of intestinal deep infiltrating endometriosis (DIE). 87 patients had complete surgery for intestinal endometriosis involving the low rectum. Ninety-seven preoperative MRI (Siemens 1, 5 T) were retrospectively reviewed by the same experienced radiologist. The main diagnosis criteria for adenomyosis were: JZ thickness > 12 mm. Diffuse and focal adenomyosis lesions were assessed and correlated with the severity of endometriosis defined as follows: total number of deep lesions, number of intestinal deep lesions, and rAFS scores. Seventy-six percent (76%) of the patients with diffuse adenomyosis had more than one intestinal deep lesion as compared to 51% of the patients without adenomyosis (OR: 3, 95% CI: 1,0-9,2; P = 0.039). The existence of focal posterior adenomyosis was significantly correlated with the number of DIE lesions: 87% of the patients with focal adenomyosis had more than 3 DIE lesions (OR: 25.6, 95% CI: 1.2-27.3). Adenomyosis, especially focal posterior adenomyosis, could be considered as a marker of severity for intestinal deep endometriosis, in terms of number of deep lesions.