Patterns of bowel involvement in deep infiltrating endometriosis: review of 284 consecutive cases

Bitti, Grazia
2011 · doi:10.1594/ecr2011/c-1042 · W6905961112
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MR imaging of 284 patients with suspected deep infiltrating endometriosis identified four distinct rectosigmoid involvement patterns and less frequent small bowel or mesenteric lesions.

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This retrospective study evaluated magnetic resonance imaging findings in 284 consecutive patients referred for suspected deep infiltrating endometriosis to characterize patterns of bowel involvement. The authors identified four distinct radiological types of rectosigmoid infiltration, ranging from thin mesorectal septa to full-thickness wall masses, while noting that small bowel and mesenteric involvement occurred less frequently. The research demonstrates that multiplanar high-resolution MRI can effectively recognize these specific morphological patterns to stage the extent of disease within the gastrointestinal tract. This paper is centrally about endometriosis — specifically the characterization of bowel involvement patterns in deep infiltrating endometriosis using MRI.

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Keywords

MR, Pelvis Authors: G. T. Bitti, G. Demurtas, S. SECCI; cagliari/IT DOI: 10.1594/ecr2011/C-1042 Purpose Endometriosis is defined as a chronic benign estrogen-dependent gynaecological disease (1), that affects millions of women of reproductive age: 10 to 15% of the female population. Different forms of disease manifestations have been described such as peritoneal endometriosis, adenomyosis uteri, ovarian endometriosis and deep infiltrating endometriosis (DIE). Deep infiltrating endometriosis (DIE) is diagnosed in 20% of women with endometriosis. Bowel endometriosis is found in 5 to 12% of patients with endometriosis, with colorectum representing 90% of all bowel locations (2). DIE is defined as the...

Methods

and Materials Retrospective evaluation on a PACS station of the MR examination in 284 consecutive patients referred for suspected endometriosis was done. MR studies were performed on a 1,5 MR unit with small FOV (20 cm) 3-5 mm FSET2 acquired on sagittal, axial and coronal planes, 5 mm axial FSE T1 with and without fat saturation. When deemed necessary, an antiperistaltic drug and/or a paramagnetic contrast media were administered intravenously; no contrast media were introduced in the rectum/vagina. Bowel endometriosis was identified and patterns of involvement were...

Results

Rectosigmoid involvement by Endometriosis was observed to range from adhesion and tethering, up to extensive full thickness wall infiltration, in a spectrum of patterns that could be easily recognized on MR: Type 1: thin mesorectal septa Type 2: mesorectal mass with or without involvement of the uterosacral ligaments Type 3: plaque with bowel retraction in a festooned appearance Type 4: fan- or crescent-shaped mass infiltrating the wall. Less frequently small bowel and mesenteric involvement was observed.

Conclusion

Multiplanar 3-5 mm FSE allowed recognition of different patterns of rectosigmoid involvement in Deep Infiltrating Endometriosis Type 1: thin mesorectal septa, Type 2: mesorectal mass with or without involvement of the uterosacral ligaments, Type 3: plaque with bowel retraction in a festooned appearance, and Type 4: fan- or crescent-shaped mass infiltrating the wall. Less frequently we observed small bowel lesions (tethering and loop adhesions) and mesenteric involvement (long septa, reticulation, increased vascular markings, decreased signal intensity). MR can be useful to stage DIE bowel involvement...

References

1) Giudice and Kao, Endometriosis. Lancet 2004; 364:1789-1799 2004;364:1789-1799 2) Darai E., Gynecol Obstet Fertil. 2008 Dec; 36(12):1214-7 3)van KaamJ., Hum Reprod. 2008 Dec; 23(12):2692-700 Fibromuscular differentiation in deeply infiltrating endometriosis is a reaction of resident fibroblasts to the presence of ectopic endometrium). 4)Stepniewska A., Hum Reprod. 2009 Jul; 24(7):1619-25. Laparoscopic treatment of bowel endometriosis in infertile women. 5) Ferrero S., Fertil Steril. 2009 Jul; 92(1):41-6. Fertility after bowel resection for endometriosis. 6) Hottat S., Radiology. 2009 Oct;253(1):126-34.Endometriosis: contribution of 3.0-T pelvic MR imaging in...

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endometriosisdie_deep_infiltrating

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