Utility of vaginal and rectal contrast medium in MRI for the detection of deep pelvic endometriosis

Madleen Chassang, Chassang M, M Chassang, Novellas S, S Novellas, C Bloch-Marcotte, Bloch-Marcotte C, J Delotte, Delotte J, Toullalan O, Olivier Toullalan, O Toullalan, A Bongain, Bongain A, P Chevallier, Chevallier P
European radiology · 2009 · vol. 20(4) , pp. 1003–1010 · doi:10.1007/s00330-009-1627-8 · PMID:19862535 · W2004563095
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⚙ AI-generated summary by claude@2026-06+body, 2026-06-13 ⓘ

Vaginal and rectal opacification with ultrasound gel significantly improved MRI sensitivity for detecting deep pelvic endometriosis by enhancing visualization of pelvic organs.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-13 · read from full text ⓘ

This prospective monocentric study evaluated whether MRI using vaginal and rectal opacification with ultrasound gel improves detection of deep pelvic endometriosis, compared with MRI without opacification. Patients assessed by a gynecologist for pelvic pain, endometriosis, or infertility underwent axial and sagittal T2-weighted MRI both pre- and post-opacification, with three blinded radiologists reading images separated by at least 15 days; sensitivity, specificity, and predictive values were calculated. Among 78 patients, 31 had deep pelvic endometriosis (24 confirmed by laparoscopy), and MRI identified 76 lesion locations, with a significant sensitivity increase after contrast medium (p < 0.0002), particularly for lesions in the vagina and rectovaginal septum. The study’s performance is limited by being monocentric and by an imperfect reference standard because not all cases were laparoscopy-confirmed. This paper is centrally about endometriosis — it tests vaginal/rectal gel opacification to improve MRI sensitivity for deep pelvic endometriosis detection.

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Abstract

ObjectiveTo study the sensitivity of MRI performed utilising vaginal and rectal opacification with ultrasound gel in the detection of deep pelvic endometriosis.Material and methodsThis was a prospective monocentric study. All patients evaluated by the gynaecologist for pelvic pain, endometriosis or infertility were included. Axial and sagittal T2-weighted images were performed both with and without vaginal and rectal opacification with ultrasound gel. Three radiologists, all blinded, interpreted the images with a minimum of 15 days between the two readings. MRI performance with and without vaginal and rectal opacification was evaluated by calculating sensitivity, specificity and both positive and negative predictive values.ResultsSeventy-eight patients were included. Among these, 31 patients had deep pelvic endometriosis of which 24 were confirmed by laparoscopy. Seventy-six locations of deep pelvic endometriosis were discovered on MRI. For the three reviewers there was a significant improvement in sensitivity between pre- and post-contrast MRI (p < 0.0002).ConclusionOpacification of the vagina and rectum significantly improved the sensitivity of MRI for the detection of deep pelvic endometriosis by expanding the vagina and rectum, thus allowing better delineation of the pelvic organs. This was especially apparent for lesions localised to the vagina and rectovaginal septum.
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Abstract

Objective To study the sensitivity of MRI performed utilising vaginal and rectal opacification with ultrasound gel in the detection of deep pelvic endometriosis.

Material and methods

This was a prospective monocentric study. All patients evaluated by the gynaecologist for pelvic pain, endometriosis or infertility were included. Axial and sagittal T2-weighted images were performed both with and without vaginal and rectal opacification with ultrasound gel. Three radiologists, all blinded, interpreted the images with a minimum of 15 days between the two readings. MRI performance with and without vaginal and rectal opacification was evaluated by calculating sensitivity, specificity and both positive and negative predictive values.

Results

Seventy-eight patients were included. Among these, 31 patients had deep pelvic endometriosis of which 24 were confirmed by laparoscopy. Seventy-six locations of deep pelvic endometriosis were discovered on MRI. For the three reviewers there was a significant improvement in sensitivity between pre- and post-contrast MRI (p < 0.0002).

Conclusion

Opacification of the vagina and rectum significantly improved the sensitivity of MRI for the detection of deep pelvic endometriosis by expanding the vagina and rectum, thus allowing better delineation of the pelvic organs. This was especially apparent for lesions localised to the vagina and rectovaginal septum. Similar content being viewed by others

References

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J Am Assoc Gynecol Laparosc 9:115–119 Bazot M, Thomassin I, Hourani R, Cortez A, Darai E (2004) Diagnostic accuracy of transvaginal sonography for deep pelvic endometriosis. Ultrasound Obstet Gynecol 24:180–185 Author information Authors and Affiliations Corresponding author Rights and permissions About this article Cite this article Chassang, M., Novellas, S., Bloch-Marcotte, C. et al. Utility of vaginal and rectal contrast medium in MRI for the detection of deep pelvic endometriosis. Eur Radiol 20, 1003–1010 (2010). https://doi.org/10.1007/s00330-009-1627-8 Received: Revised: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s00330-009-1627-8

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Condition tags

endometriosis

MeSH descriptors

Contrast Media Endometriosis Image Enhancement Magnetic Resonance Imaging Pelvis Rectum Vagina Adolescent Adult Endometriosis Female Humans Image Enhancement Magnetic Resonance Imaging Middle Aged Pelvis Rectum Reproducibility of Results Sensitivity and Specificity Vagina

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