How to improve MRI accuracy in detecting deep infiltrating colorectal endometriosis: MRI findings vs. laparoscopy and histopathology

Valentini AL, Anna Lia Valentini, Benedetta Gui, Maura Miccò, Mingote MC, Maria Carla Mingote, Valeria Ninivaggi, Ninivaggi V, Maurizio Guido, Zannoni GF, Gian Franco Zannoni, Marrucci E, Eleonora Marrucci, Lorenzo Bonomo, Bonomo L
La Radiologia medica · 2013 · vol. 119(5) , pp. 291–297 · doi:10.1007/s11547-013-0336-1 · PMID:24297583 · W2064489942
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⚙ AI-generated summary by claude@2026-06+body, 2026-06-12 ⓘ

A revised MRI diagnostic criterion, incorporating nodules or plaque-like lesions with a "radial and retracting shape" in the bowel wall, significantly improves accuracy in detecting deep infiltrating colorectal endometriosis compared to previous methods.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 · read from full text ⓘ

This retrospective study evaluated whether combining specific MRI findings improves diagnostic accuracy for deep infiltrating colorectal endometriosis (DICE) in women undergoing MRI for suspected disease, with inclusion limited to those who also had laparoscopy, and comparison of MRI interpretations against laparoscopy and/or histopathology as gold standards. Two radiologists assessed images using two diagnostic criteria: the first based on the presence of nodules or hypointense plaque-like lesions with adjacent fat-plane involvement and bowel wall thickness, without considering a “radial and retracting” semicircular configuration, and the second adding that “radial and retracting shape.” Agreement was poor with the first criterion (51.5%, k=0.20) but markedly improved with the second criterion (96.9%, k=0.93), and the authors report that likelihood ratios did not improve the diagnostic value in the first criterion but did with the second. This paper is centrally about endometriosis—specifically improving MRI-based detection of deep infiltrating colorectal endometriosis using an association of MRI findings and laparoscopy/histopathology validation.

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Abstract

ObjectiveTo verify whether the capability of magnetic resonance imaging (MRI) in diagnosing deep infiltrating colorectal endometriosis (DICE) is improved using an association of MRI findings.Methods and materialsThe imaging database of our Institute of Radiology was retrospectively reviewed to identify patients subjected to MRI for a suspicion of deep infiltrating endometriosis. Medical history was then investigated and only patients who were also subjected to laparoscopy (LA) were included. Absence of LA represented the exclusion criterion. Images were evaluated twice by two radiologists using two different diagnostic criteria for an abnormal result: the contemporary presence of nodules or hypointense plaque-like lesions in the adjacent fat plane and bowel wall thickness, without (first criterion) or with (second criterion) semicircular shape (i.e. "radial and retracting shape"). Radiologists worked in consensus evaluating images in two separate sessions, using the first criterion in the first section and the second criterion in the second one. MRI results were compared with LA or histopathology as the gold standard by 2 × 2 tables and statistically analyzed (k statistics). Likelihood-ratio test was also performed, being independent from the prevalence of the disease.ResultsBy consulting case sheets, 33/50 females (ranging age 24-39 years, mean age 32.2 years) who were subjected to MRI also underwent LA. Intestinal resection for DICE was performed in 11/33 patients; in 22/33 superficial intestinal foci, adhesions/nodules in the fat plane were simply removed. When the first criterion was applied, MRI agreement with histopathology or LA was poor (51.5 %) (k value = 0.20; p < 0.055), while it was improved (96.9 %) when using the second diagnostic criterion (k value = 0.93; p < 0.0000). Likelihood ratio was 1.375 (95 % CI 0.69-2.72) using the first and 22 (95 % CI 20.08-24.1) using the second criterion.ConclusionThe second criterion, or the joint presence of nodules or hypointense plaque-like lesions in the adjacent fat plane and bowel wall thickness showing "radial and retracting shape", improves MRI capability in DICE diagnosis. It can be considered an effective indicator of DICE on T2-weighted images at 1.5-T MRI, and can ensure the correct preoperative assessment of the disease for the best therapeutic procedure and treatment planning.
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Abstract

Objective To verify whether the capability of magnetic resonance imaging (MRI) in diagnosing deep infiltrating colorectal endometriosis (DICE) is improved using an association of MRI findings.

Methods

and materials The imaging database of our Institute of Radiology was retrospectively reviewed to identify patients subjected to MRI for a suspicion of deep infiltrating endometriosis. Medical history was then investigated and only patients who were also subjected to laparoscopy (LA) were included. Absence of LA represented the exclusion criterion. Images were evaluated twice by two radiologists using two different diagnostic criteria for an abnormal result: the contemporary presence of nodules or hypointense plaque-like lesions in the adjacent fat plane and bowel wall thickness, without (first criterion) or with (second criterion) semicircular shape (i.e. “radial and retracting shape”). Radiologists worked in consensus evaluating images in two separate sessions, using the first criterion in the first section and the second criterion in the second one. MRI results were compared with LA or histopathology as the gold standard by 2 × 2 tables and statistically analyzed (k statistics). Likelihood-ratio test was also performed, being independent from the prevalence of the disease.

Results

By consulting case sheets, 33/50 females (ranging age 24–39 years, mean age 32.2 years) who were subjected to MRI also underwent LA. Intestinal resection for DICE was performed in 11/33 patients; in 22/33 superficial intestinal foci, adhesions/nodules in the fat plane were simply removed. When the first criterion was applied, MRI agreement with histopathology or LA was poor (51.5 %) (k value = 0.20; p < 0.055), while it was improved (96.9 %) when using the second diagnostic criterion (k value = 0.93; p < 0.0000). Likelihood ratio was 1.375 (95 % CI 0.69–2.72) using the first and 22 (95 % CI 20.08–24.1) using the second criterion.

Conclusion

The second criterion, or the joint presence of nodules or hypointense plaque-like lesions in the adjacent fat plane and bowel wall thickness showing “radial and retracting shape”, improves MRI capability in DICE diagnosis. It can be considered an effective indicator of DICE on T2-weighted images at 1.5-T MRI, and can ensure the correct preoperative assessment of the disease for the best therapeutic procedure and treatment planning. Similar content being viewed by others

References

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endometriosis

MeSH descriptors

Colonic Diseases Endometriosis Image Enhancement Laparoscopy Magnetic Resonance Imaging Rectal Diseases Adult Colonic Diseases Colonic Diseases Colonic Diseases Contrast Media Endometriosis Endometriosis Endometriosis Female Humans Image Enhancement Imaging, Three-Dimensional Magnetic Resonance Imaging Meglumine

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