Deep Infiltrating Endometriosis

Jung SI, Sung Il Jung, Young Jun Kim, Kim YJ, Hae Jeong Jeon, Jeon HJ, Kyung-Ah Jeong, Jeong KA
Journal of computer assisted tomography · 2010 · vol. 34(3) , pp. 338–342 · doi:10.1097/rct.0b013e3181cda07c · PMID:20498532 · W2009107690
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Computed tomography imaging was evaluated for depicting deep-infiltrating endometriosis, with tethered rectum found to be the most specific CT finding.

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This retrospective study evaluated the feasibility of computed tomography in depicting deep-infiltrating endometriosis among 54 patients with histologically confirmed ovarian endometriomas. Two radiologists independently reviewed preoperative CT images for specific signs such as rectal tethering, periuterine fat stranding, and uterosacral ligament thickening, comparing these findings against surgical and pathologic confirmation. The results indicated that a tethered appearance of the rectum was the most specific diagnostic sign, while the overall sensitivity and accuracy of CT findings were moderate. This paper is centrally about endometriosis — specifically the imaging characteristics and diagnostic utility of CT for deep infiltrating lesions.

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Abstract

OBJECTIVE: To retrospectively evaluate the feasibility of computed tomography (CT) in depicting deep-infiltrating endometriosis. MATERIALS: The study population included 54 patients (age: mean, 35.5 years; range, 23-48 years) with histologically confirmed ovarian endometriomas between January 2007 and July 2009. All the patients underwent preoperative CT imaging before laparotomy or laparoscopy. The CT images were evaluated for the presence of a tethered appearance of the rectum in the direction of the uterus, stranding of periuterine pelvic fat, thickening of the uterosacral ligament, and retroflexed uterus. Two radiologists performed a blinded and independent review for each CT finding. The sensitivity, the specificity, the positive predictive value, the negative predictive value, and the accuracy of each CT finding and kappa statistics were determined. RESULTS: Deep-infiltrating endometriosis was confirmed after surgery and pathologic examination in 34 patients (63.0%). The most specific finding for the diagnosis of deep-infiltrating endometriosis was tethered appearance of rectum in the direction of the uterus (90.0%). The mean sensitivity, specificity, positive predictive value, negative predictive value, and accuracy values of all the CT findings except that of retroflexed uterus were 56.9%, 70.0%, 78.1%, 60.4%, and 61.7%, respectively. The mean kappa value was 0.82 (range, 0.67-0.96). CONCLUSIONS: Computed tomographic imaging may constitute another potential option as a complementary imaging modality for the evaluation of deep-infiltrating endometriosis.
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Objective

To retrospectively evaluate the feasibility of computed tomography (CT) in depicting deep-infiltrating endometriosis.

Materials

The study population included 54 patients (age: mean, 35.5 years; range, 23-48 years) with histologically confirmed ovarian endometriomas between January 2007 and July 2009. All the patients underwent preoperative CT imaging before laparotomy or laparoscopy. The CT images were evaluated for the presence of a tethered appearance of the rectum in the direction of the uterus, stranding of periuterine pelvic fat, thickening of the uterosacral ligament, and retroflexed uterus. Two radiologists performed a blinded and independent review for each CT finding. The sensitivity, the specificity, the positive predictive value, the negative predictive value, and the accuracy of each CT finding and κ statistics were determined.

Results

Deep-infiltrating endometriosis was confirmed after surgery and pathologic examination in 34 patients (63.0%). The most specific finding for the diagnosis of deep-infiltrating endometriosis was tethered appearance of rectum in the direction of the uterus (90.0%). The mean sensitivity, specificity, positive predictive value, negative predictive value, and accuracy values of all the CT findings except that of retroflexed uterus were 56.9%, 70.0%, 78.1%, 60.4%, and 61.7%, respectively. The mean κ value was 0.82 (range, 0.67-0.96).

Conclusions

Computed tomographic imaging may constitute another potential option as a complementary imaging modality for the evaluation of deep-infiltrating endometriosis.

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Condition tags

endometriosisdie_deep_infiltrating

MeSH descriptors

Endometriosis Tomography, X-Ray Computed Tomography, X-Ray Computed Adult Endometriosis Endometriosis Endometriosis Female Humans Middle Aged Predictive Value of Tests Retrospective Studies Sensitivity and Specificity

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