Ureteral endometriosis: MR imaging appearance for predicting complex procedures

Rennan Ling, Ling Rennan, Shuo Yao, Hongtao Jin, Qinqin Yi, Yan Wang, Yi Yang
Heliyon · 2024 · vol. 10(17) , pp. e34884 · doi:10.1016/j.heliyon.2024.e34884 · PMID:39319158 · PMC11419901 · W4400839467
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Ureteral wall thickening on MRI accurately predicted intrinsic ureteral endometriosis and the need for complex surgical procedures.

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Abstract

Rationale and ObjectivesTo describe MRI characteristics of ureteral endometriosis (UE) in identifying intrinsic involvement of the ureteric wall and predicting complex procedures.MethodsThirty- three UE lesions in 30 patients treated for UE over a 20-year period were reviewed. A systematic analysis of 13 MRI (ureteric wall thickening, circumference, T1 signal, T2 signal, ureterectasis, lateral parametrial endometriosis (LPE), rectal endometriosis, the foregoing three-characteristic diameter, ovarian endometriomas, adenomyosis, paraurethral endometriosis) and 5 clinical (age, BMI, CA125, creatinine and rAFS stage) characteristics was performed. MRI results were compared to histology and surgical procedure performed (simple versus complex ureteral procedures).ResultsTwenty-five extrinsic and 8 intrinsic UE were pathologically identified. Twenty lesions underwent a simple procedure, and 12 underwent a complex procedure, with 1 ureteroscopic biopsy. There were significant differences in the characteristics of ureteric wall thickening, the diameter of dilated ureter and LPE, rectal endometriosis and adenomyosis between extrinsic and intrinsic UE (p<0.05). UE was associated with LPE (p=0.033). The criteria of ureteral wall thickening more accurately predicted intrinsic UE than circumference, but the AUC was not significant difference (AUC, 0.806 and 0.639; 95% CI, [0.594, 0.937] and [0.419, 0.823], respectively; p=0.350). There were significant differences in creatinine, thickening and adenomyosis between the simple and complex procedures (p<0.05). In 11 lesions with the absence of ureterectasis, 4 lesions with hydronephrosis and thickening were intrinsic and underwent complex procedures, while 7 lesions extrinsic and simple.ConclusionsUreteric wall thickening as a analytical criterion may accurately predict intrinsic UE and complex ureteric procedures.

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Condition tags

endometriosisadenomyosis

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chemicals 9
creatinine creatinine carbohydrate creatinine water gadoterate meglumine creatinine creatinine creatinine
organisms 1
noordeloos 2009062

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