OC11.05: Accuracy of transvaginal sonography and contrast‐enhanced MR‐colonography for the pre‐surgical assessment of deep pelvic endometriosis

To investigate accuracy of TVS and contrast-enhanced MR-colonography (CE-MR-C) for pre-surgical assessment of deep pelvic endometriosis. Prospective, single center study (January 2010–January 2011). Twenty-five women with suspicious of DPE. Patients underwent TVS and CE-MR-C, performed blindly. TVS technique: 5 MHz probe, dynamic, tranlabial and transvaginal approach, painful sites mapping. DP lesions: hypoechoic nodule and/or hyperechoic thickening at torus uterinus, utero-sacral ligaments, recto-vaginal septum and vesico-uterine pouch. Deep bowel involvement: hypoechoic nodule of muscularis propria. Adhesions: absence of sliding sign, indian headdress sign for bowel, hyperechoic thickening and pouch of Douglas obliteration. CE-MR-C technique: 1.5-T device, 4-channel phased array coil, bowel preparation, colon distension with 1.5 liter water enema and injection of gadolinium-DTPA. DP lesions: hyperintense haemorrhagic foci on T1-weighted images, fat-suppressed T1-w, nodules or spiculated hypointense lesions on T2-w and hyperintense foci on T1-w. Deep bowel involvement: hypointense nodule or plaque of bowel wall with contrast enhancement. Adhesions: loss of fat tissue between organs and abnormal angulation of bowel loops. Patients underwent laparoscopic treatment and specimens had pathologic examination. Accuracy for TVS and CE-MR-C respectively: torus uterinus, utero-sacral ligaments: 76%, 75%. Recto-vaginal septum: 80%, 80%. Sigma-rectum: 84%, 96%. One vesico-uterine pouch and three ureteral nodules with concordant diagnosis; one ileal and cecal nodule recognized only by MRI. Pathologic confirmation in all cases. No statistically significant differences were found (P value < 0.05). TVS is a powerful tool for preoperative staging of DPE. CE-MR-C could be reserved for cases with deep infiltrating recto-sigmoid lesions to evaluate the grade of stenosis with an ‘X-ray free’ technique and to visualize the involvement of the upper part of colon and small intestine.