Diagnosis of colorectal endometriosis: contribution of contrast enhanced MR-colonography

Arnaldo Scardapane, Stefano Bettocchi, Filomenamila Lorusso, Lorusso F, Amato Antonio Stabile Ianora, Stabile Ianora AA, Antonella Vimercati, Oronzo Ceci, Maurilia Lasciarrea, Ceci O, Lasciarrea M, Giuseppe Angelelli, Angelelli G
European radiology · 2011 · vol. 21(7) , pp. 1553–1563 · doi:10.1007/s00330-011-2079-5 · PMID:21336537 · W2081078107
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⚙ AI-generated summary by claude@2026-07, 2026-07-09 ⓘ

Contrast-enhanced MR-colonography improved sensitivity, specificity, and accuracy for diagnosing colorectal endometriosis and increased interobserver agreement compared to standard MRI.

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⚙ AI-generated deep summary by claude@2026-07, 2026-07-09 · read from full text ⓘ

This prospective study enrolled 104 women with suspected endometriosis to evaluate whether contrast-enhanced MR-colonography (CE-MR-C), performed after pelvic high-resolution MRI and colonic distension with a water enema plus gadolinium-DTPA, improves diagnosis of intestinal endometriosis compared with pelvic HR-MRI alone. Two radiologists independently reviewed the two MRI datasets, with laparoscopy used as the reference standard and deep pelvic endometriotic lesions recorded with attention to colorectal involvement. CE-MR-C increased sensitivity, specificity, PPV, NPV, and overall accuracy for colorectal endometriosis for both radiologists and also improved interobserver agreement (Cohen’s kappa from 0.63 to 0.80). The main limitation explicitly highlighted by the study design is the need for contrast administration and colonic distension as part of the imaging protocol. This paper is centrally about endometriosis — specifically the diagnosis of colorectal (intestinal) endometriosis and how CE-MR-colonography improves diagnostic performance.

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Abstract

ObjectiveTo investigate the contribution of contrast-enhanced MR-colonography (CE-MR-C) for the diagnosis of intestinal endometriosis.MethodsOne hundred and four women with suspected endometriosis were prospectively enrolled. All patients were subjected to MRI consisting of two phases: pelvic high-resolution MRI (HR-MRI) followed by CE-MR-C after colonic distension using a 1.5-liter water enema and injection of 0.15 ml/kg of 0.5 M gadolinium-DTPA with T1w high-resolution isotropic volume (THRIVE) and balanced turbo field echo (BTFE) images. HR-MRI and CE-MR-C were considered as two datasets, which were independently reviewed by two radiologists with 12 and 2 years' experience respectively. The presence of deep pelvic endometriotic lesions with particular attention to colorectal involvement was recorded.ResultsMRI findings correlated with laparoscopy in all cases. Thanks to CE-MR-C images, sensitivity, specificity, PPV, NPV and accuracy for diagnosis of colorectal endometriosis increased from 76%, 96%, 84%, 93% and 91%, to 95%, 97%, 91%, 99% and 97% for the most experienced radiologist and from 62%, 93%, 72%, 89% and 85%, to 86%, 94%, 82%, 96% and 92% for the less experienced radiologist; moreover, the interobserver agreement increased from 0.63 to 0.80 (Cohen's K test).ConclusionCE-MR-C allows easier recognition of colorectal endometriosis and higher interobserver agreement.
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Abstract

Objective To investigate the contribution of contrast-enhanced MR-colonography (CE-MR-C) for the diagnosis of intestinal endometriosis.

Methods

One hundred and four women with suspected endometriosis were prospectively enrolled. All patients were subjected to MRI consisting of two phases: pelvic high-resolution MRI (HR-MRI) followed by CE-MR-C after colonic distension using a 1.5-liter water enema and injection of 0.15 ml/kg of 0.5 M gadolinium-DTPA with T1w high-resolution isotropic volume (THRIVE) and balanced turbo field echo (BTFE) images. HR-MRI and CE-MR-C were considered as two datasets, which were independently reviewed by two radiologists with 12 and 2 years’ experience respectively. The presence of deep pelvic endometriotic lesions with particular attention to colorectal involvement was recorded.

Results

MRI findings correlated with laparoscopy in all cases. Thanks to CE-MR-C images, sensitivity, specificity, PPV, NPV and accuracy for diagnosis of colorectal endometriosis increased from 76%, 96%, 84%, 93% and 91%, to 95%, 97%, 91%, 99% and 97% for the most experienced radiologist and from 62%, 93%, 72%, 89% and 85%, to 86%, 94%, 82%, 96% and 92% for the less experienced radiologist; moreover, the interobserver agreement increased from 0.63 to 0.80 (Cohen’s K test).

Conclusion

CE-MR-C allows easier recognition of colorectal endometriosis and higher interobserver agreement. Similar content being viewed by others

References

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Acknowledgements

The authors wish to thank Ms. Paulene Butts for preparing the English version of the manuscript, Dr. Domenico Piscitelli, Department of Pathology of the University Hospital “Policlinico” of Bari (Italy) for furnishing figures 1-f and 6-f and Salvatore De Ceglie, radiological technologist, for carrying out MR examinations. Author information Authors and Affiliations Corresponding author Rights and permissions About this article Cite this article Scardapane, A., Bettocchi, S., Lorusso, F. et al. Diagnosis of colorectal endometriosis: contribution of contrast enhanced MR-colonography. Eur Radiol 21, 1553–1563 (2011). https://doi.org/10.1007/s00330-011-2079-5 Received: Revised: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s00330-011-2079-5

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Condition tags

endometriosis

MeSH descriptors

Colonic Diseases Endometriosis Magnetic Resonance Imaging Rectal Diseases Adult Colonic Diseases Colonic Diseases Contrast Media Endometriosis Endometriosis Female Gadolinium DTPA Humans Image Interpretation, Computer-Assisted Laparoscopy Magnetic Resonance Imaging Predictive Value of Tests Prospective Studies Rectal Diseases Rectal Diseases

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