A novel technique using magnetic resonance imaging jelly for evaluation of rectovaginal endometriosis

OBJECTIVE: To evaluate the usefulness of the magnetic resonance imaging (MRI) jelly method as a preoperative diagnostic means for patients with rectovaginal endometriosis. DESIGN: Prospective study. SETTING: University hospital. PATIENT(S): Thirty one patients with suspected rectovaginal endometriosis based on clinical symptoms and the results of preoperative pelvic, rectal, and ultrasonographic examinations, who were scheduled to undergo laparoscopic surgery. INTERVENTION(S): Before surgery, jelly for ultrasonography was injected into the vagina and rectum for MRI. The MRI findings were compared with findings obtained through laparoscopic surgery and histopathologic examination of the removed tissues. MAIN OUTCOME MEASURE(S): The complete cul-de-sac obliteration and deep lesion confirmed at the time of the laparoscopic surgery were evaluated by the MRI jelly method. RESULT(S): For detecting the presence of complete obliteration of the cul-de-sac, the accuracy of the diagnosis of rectovaginal endometriosis attained using the MRI jelly method was sensitivity 90.9% and specificity 77.8%. For the presence of a deep lesion, the sensitivity was 94.1% and specificity 100%. CONCLUSION(S): The condition of the cul-de-sac could be imaged clearly via the MRI jelly method. Not only rectovaginal endometriosis presenting with deep lesions, but also complete cul-de-sac obliteration alone could be diagnosed preoperatively at a high rate.