Deep pelvic endometriosis: MR evaluation

Ramiro Méndez
2012 · doi:10.1594/ecr2012/c-2074 · W2512219620
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This paper evaluates the utility of MRI for assessing deep pelvic endometriosis, highlighting its role in diagnosis and surgical planning.

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This educational poster evaluates the utility of magnetic resonance imaging for diagnosing deep pelvic endometriosis, emphasizing that while such implants are less common than ovarian lesions, they are strongly associated with clinical symptoms and infertility. The authors describe a dedicated MRI protocol utilizing 1.5 T magnets and specific fast spin echo sequences to detect subtle lesions, noting that vaginal and rectal distension with fluid or gel significantly aids in visualizing deep implants in the posterior compartment. The study concludes that appropriate MR protocols are essential for accurately staging these conditions to guide surgical excision when medical treatments fail. This paper is centrally about endometriosis — specifically the preoperative imaging and staging of deep infiltrating endometriotic implants using magnetic resonance techniques.

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Abstract

Poster: ECR 2012 / C-2074 / Deep pelvic endometriosis: MR evaluation by: R. J. Mendez, J. Barrera Ortega; Madrid/ES
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Keywords

Abdomen, Genital / Reproductive system female, MR, Contrast agent-other, Education, Blood, Haemorrhage Authors: R. J. Méndez, J. Barrera Ortega; Madrid/ES DOI: 10.1594/ecr2012/C-2074 Learning objectives -Deep endometriotic implants in the pelvis are not as common as ovarian endometriosis, but they are more frequently related with clinical symptoms and infertility. -When medical treatment fails to control symptoms, surgical excision of the endometriotic foci is the treatment of choice. -MRI is the best imaging technique to preoperatively detect and stage deep endometriotic implants in the pelvis, but a dedicated MR protocol is needed. Patient preparation is also commented. -Many times, MRI findings are subtle and a careful analysis of the images is...

Background

Endometriosis is defined as the presence of endometrial tissue in an ectopic location, outside of the uterine cavity. It is frequent among women in childbearing age. Endometriosis is often almost asymptomatic but it is among the leading causes of infertility and pelvic pain. The most frequent locations for the endometriotic implants are the ovaries and the peritoneal surface. Pathogenesis of this disease is under discussion and it is probably multiple. Most of the endometriotic lesions could be explained by the theory of the “retrograde menstruation”... Imaging findings OR Procedure details Magnetic Resonance Technique MRI studies presented in this poster were acquired on 1.5 T MR magnets, Signa Excite (General Electric Medical Systems). For signal reception an 8 element phased array surface pelvic coil was used. -Three series of fast spin echo (FSE) T2 weighted images were acquired in sagittal, coronal and axial planes and a FSE T2 fat suppressed series. Acquisition parameters were TR: 3900-4200 ms TE: 85-110 ms, echo train (ETL) 17-21, slice thickness 4-5 mm, gap: 0.5-1 mm, FOV 20-22 cm, matrix 416-320...

Conclusion

MRI is a useful technique for the diagnosis of deep endometriosis in the pelvis. Detecting the location and extent of deep endometriotic implants can be of value to decide the therapeutic approach and serve as a guide for laparoscopic surgery. MRI can also have a role in postsurgical evaluation of complex cases. An appropriate MR study protocol is required for a correct assessment of the lesions. Vaginal and rectal distension, using fluid or gel, facilitates the detection of deep endometriotic implants in the posterior compartment... Personal Information Ramiro J Méndez , Jerónimo Barrera R M Nª Sra del Rosario Hospital Clínico San Carlos Madrid. Spain Contact: [email protected]

References

1.-Loubeyre P, Petignat P, Jacob S, Egger JF, Dubuisson JB, Wenger JM. Anatomic distribution of posterior deeply infiltrating endometriosis on MRI after vaginal and rectal gel opacification. AJR 2009; 192:1625-31. 2.-Saba L, Guerriero S, Sulis R et al. Learning curve in the detection of ovarian and deep endometriosis by using Magnetic Resonance. Comparison with surgical results. Eur J Radiol 2011;79:237-44 3.-Chassang M, Novellas S, Bloch-Marcotte C et al. Utility of vaginal and rectal contrast medium in MRI for the detection of pelvic endometriosis. Eur Radiol...

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Condition tags

endometriosis

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