MRI characteristics of deep infiltrating endometriosis: correlation with clinical symptoms

Objective. To study the correlation between structural characteristics, localization of deep infiltrating endometriosis (DIE) according to magnetic resonance imaging (MRI) and the severity of clinical symptoms, as well as to evaluate the diagnostic accuracy of MRI using the ENZIAN classification and compare it with laparoscopic findings. Patients and methods. This retrospective study included 81 patients with histologically verified diagnosis of endometriosis, who had pain syndrome and/or DIE; who planned pregnancy and/or had DIE without clinical symptoms; who had diagnosed infertility. At the preoperative stage, all patients underwent pelvic MRI by a high-level specialist. Results. The ENZIAN classification for preoperative non-invasive diagnosis with sensitivity up to 95% and specificity up to 98% helps to estimate the volume and localization of lesions. Analysis of the correlation between clinical symptoms and endometrioid lesions by ENZIAN compartments showed a strong correlation for compartment A and dyspareunia (V = 0.32, p = 0.04), moderate correlation with adhesion (V = 0.337, p = 0.002) and displacement of the ovaries (V = 0.344, p = 0.002) and dysmenorrhea, and strong correlation with infertility and presence of tubo-ovarian abscess (V = 0.703, p < 0.001). Clinical symptoms of the disease depended on the height of lesion localization relative to the vaginal vestibule and anus. In this regard, in some patients, combined lesions in the retrocervical and other areas may not exhibit active clinical symptoms when the lesion is highly localized. Conclusion. MRI plays a particularly important role in the diagnosis of latent forms of DIE in the absence of clinical symptoms, as well as in the context of early diagnosis of the disease and timely initiation of pharmacotherapy as part of a long-term management strategy in this group of patients. Key words: deep infiltrating endometriosis, endometriosis, magnetic resonance imaging, diagnosis