MRI Classification of Uterosacral Ligament Involvement in Endometriosis: the Hôtel-Dieu (HTD) classification

Hélage, Siegfried
2024 · doi:10.26044/ecr2024/c-10771 · W6927282860
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This paper established an MRI classification for uterosacral ligament (USL) involvement in deep endometriosis by correlating preoperative MRI features with positive predictive values determined from histopathology. Using retrospective data from 22 women with clinical suspicion of deep endometriosis, all of whom underwent MRI and subsequent laparoscopic surgery, the authors developed semi-objective T2-weighted MRI descriptors and identified six USL types grouped into radiological categories. They reported that one linear USL type (type 1) could be not visible on MRI despite histopathological positivity, and the classification assigns a 1–6 scale to reflect the likelihood of deep endometriosis based on PPV ranges, with an explicit limitation being the small sample size. This paper is centrally about endometriosis — it introduces the Hôtel-Dieu (HTD) MRI classification specifically for uterosacral ligament involvement in deep endometriosis.

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Keywords

Genital / Reproductive system female, Pelvis, MR, Diagnostic procedure, Obstetrics Authors: S. Hélage DOI: 10.26044/ecr2024/C-10771 Purpose Aim:To establish the first-ever MRI classification of uterosacral ligament (USL) involvement in deep endometriosis (DIE), based on reliable preoperative MRI features correlated with positive predictive values (PPVs) determined through histopathological analysis.Introduction:Endometriosis is a common gynecological condition which affects approximately 10% of women of reproductive age; in selected populations, such as patients with pelvic pain or infertile women, the prevalence may attain 70% [1].DIE more frequently involve the USLs with a prevalence of approximately 70% in patients with endometriosis [2-3]. Up to now, no real consensus...

Methods

and materials Study population: Our study population included retrospectively 22 women (mean age 27) who underwent MRI in our university hospital for clinical suspicion of DIE upon variable symptoms before surgery, from October 2008 to November 2016. All patients presented with pain symptoms (dysmenorrhea, dyspareunia, and chronic pelvic pain) for more than 6 months. All patients underwent laparoscopic examination and surgery. The diagnosis of endometriosis involving a USL was proved at histopathology.MRI protocol: MRIs were performed on 1.5T systems (Achieva®, Philips Healthcare, Netherlands; Aera®, Siemens Healthcare, Germany;...

Results

The six types of USL: The “L-category” corresponded to linear types, with regular or irregular margins, and included types 1, 2, 3A and 3B. A type 1 USL was not visible on MRI scans despite a positive histopathological examination (Figure 1). A type 2 USL was visible but either not measurable (i.e. thickness ≤ 1 mm) or measurable with a mild thickening ranging from 1 to 2 mm included; a type 2 USL displayed a smooth surface with regular margins and had usually a longitudinally...

Conclusion

We defined two radiological categories of USL, based on their MRI aspect, matching with two different ranges of PPV. We have thus developed an MRI classification system for USLs using semi-objective descriptors for each plane of section in T2WI. Our system assigns a scale of 1 to 6 to indicate the possibilities of DIE.- The “L-category” corresponded to linear types, with regular or irregular margins, and included types 1, 2, 3A and 3B. For the L-category, PPVs ranged from 75% to 88%, depending on the...

References

[1] Giudice LC. Clinical practice. Endometriosis. N Engl J Med 2010 Jun 24;362(25):2389-98. [2] Sampson JA. Peritoneal endometriosis due to menstrual dissemination of endometrial tissue into the peritoneal cavity. Am J Obstet Gynecol 1927;14:422-69. [3] 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(1):157-61. [4] Bazot M, Gasner A, Ballester M, et al. Value of thin section oblique axial T2-weighted magnetic resonance images to assess uterosacral ligament endometriosis. Hum Reprod...

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