Figure 1 - uploaded by Jean-François F Moreau
Content may be subject to copyright.
Deep endometriosis of the right uterosacral ligament (USL) extending to the rectal wall muscles in a 32 year old woman. (A) Axial T2-weighted image obtained with the body coil shows a hypointense nodule on the proximal part of the right USL (arrow) and a normal regular left USL (arrowheads). (B) Axial T2weighted image obtained with an endorectal cervix coil demonstrates an enlarged right uterosacral ligament (arrow) with a proximal nodule (arrowhead) extending up to the rectum (small arrow).
Source publication
The aim of this study was to describe magnetic resonance (MR) imaging findings in histopathologically proven deep endometriosis infiltrating the uterosacral ligaments, the pouch of Douglas, the rectum or the bladder. Twenty patients presenting with a clinical suspicion of deep endometriosis underwent preoperative MR imaging. Sagittal and axial fast...
Contexts in source publication
Context 1
... ligaments with deep endometriosis were irregu- lar due to the presence of a proximal nodule measuring between 10 and 18 mm in largest diameter (mean 13.4 mm) ( Figures 1-3). T2-signal intensity of the nodule was iso-(6/12), hypo- (5/12) or hyperintense to the myometrium (1/12); the nodule was isointense (6/6) when identified on T1-weighted SE imaging. ...
Context 2
... normal hyposignal of the rectal muscu- laris propria was visible only in patients presenting a distended rectum, as it occurred incidentally by the intrarectal position of the receiver coil. Deep rectal wall invasion corresponded to an interruption of the hyposignal of the rectal muscular propria on T2-weighted spin echo images (Figure 1b). Exten- sion to the rectum could not be analysed in patients with an endovaginal position of the coil due to absent rectal distension. ...
Similar publications
Background
More than 70% of human immunodeficiency virus (HIV)-positive children sustain respiratory diseases in their lifetime. Imaging plays an important role in establishing early and correct diagnosis.
Objective
To evaluate the diagnostic accuracy of 3-Tesla (T) thorax MRI in HIV-positive children, using chest CT as the gold standard.
Materia...
Traditional nuclear magnetic resonance (NMR) spectroscopy relies on the versatile chemical information conveyed by spectra. To complement conventional NMR, Laplace NMR explores diffusion and relaxation phenomena to reveal details on molecular motions. Under a broad concept of ultrafast multidimensional Laplace NMR, here we introduce an ultrafast di...
A novel method is presented for fully automatic detection of candidate white matter (WM) T1 hypointense lesions in three-dimensional high-resolution T1-weighted magnetic resonance (MR) images. By definition, T1 hypointense lesions have similar intensity as gray matter (GM) and thus appear darker than surrounding normal WM in T1-weighted images. The...
We theoretically investigate the influence of the fluctuating Overhauser
field on the spin of an electron confined to a quantum dot (QD). The
fluctuations arise from nuclear angular momentum being exchanged between
different nuclei via the nuclear magnetic dipole coupling. We focus on the role
of the nuclear electric quadrupole moments (QPMs), whic...
Molecular dynamics in binary mixtures of water and glycerol was studied by measuring the spectrum of water velocity auto-correlation in the frequency range from 0.05 - 10 kHz by using the NMR method of modulated gradient spin echo. The method shows that the diversity of diffusion signature in the short spin trajectories provides information about h...
Citations
... 18 Endometriosis can often appear as T1 hyperintense, T2 hypointense lesions. 19 ...
... Complete surgical treatment of DE through laparoscopy can be challenging, as it may involve nongynecological organs, such as the bowel and urinary tract, requiring a multidisciplinary surgical team. Therefore, for the prediction of disease extension and proper preoperative surgical planning, complementary imaging examinations are necessary [9]. ...
PurposeMRI plays an important role in the diagnosis and surgical planning of pelvic endometriosis (PE), and imaging reports should contain all relevant information (completeness). As structured reports are being increasingly utilized, we aimed to evaluate whether structured MRI reporting increases the quality of reports regarding completeness and, consequently, their perceived value by gynecologists, in comparison to free-text reports. We also aimed to compare the diagnostic performance of both formats.Methods
We retrospectively included 28 consecutive women with histologically proven PE who underwent MRI within one month before surgery. Two abdominal radiologists (Rd1/Rd2, 3y/12y experience), blinded to clinical and surgical data, individually elaborated free-text reports and, four months later, structured reports. Completeness (defined as description of six key anatomical sites deemed essential for surgical planning in a consensus of four-blinded external experts) and diagnostic performance (sensitivity and specificity) by site (histology as reference) were compared between reports using the McNemar test. The satisfaction of gynecologists was compared using the marginal homogeneity test.ResultsStructured reporting increased completeness for both Rd1 (rectosigmoid, retrocervical/uterosacral ligament, vagina, and ureter) and Rd2 (vagina, ureter, and bladder) (p < 0.05), without compromising sensitivity or specificity at any of the evaluated sites. Gynecologists’ satisfaction was superior with structured reports in most comparisons.Conclusion
Structured MRI reports perform better in fully documenting essential features of PE and are similar in terms of diagnostic performance, therefore having higher potential for surgical planning. Gynecologists found them easier to assess and were more satisfied with the information provided by structured reports.
... In patients with previous equivocal TVS, magnetic resonance imaging (MRI) is currently recommended as a second-line technique in the preoperative workup of patients with DE [60]. However, over the last 20 years, MRI has been widely used for the diagnosis of DE, including rectosigmoid nodules [61,62]. A systematic review and meta-analysis compared the accuracy of TVS and MRI in diagnosing DE [63]. ...
Transvaginal ultrasonography (TVS) should be the first-line investigation in patients with suspicion of deep endometriosis and, in particular, of rectosigmoid endometriosis. TVS cannot assess the presence of intestinal nodules located proximally to the sigmoid (such as ileal or cecal endometriotic nodules) because these lesions are beyond the field of the transvaginal probe. The ultrasonographic findings of rectosigmoid endometriosis are the presence of an irregular hypoechoic nodule in the anterior wall of the rectosigmoid colon. The learning curve for diagnosing rectosigmoid endometriosis by TVS is quite short; approximately 40 scans are required to a sonographer trained in general gynecologic ultrasonography to become proficient at diagnosing bowel endometriosis. Several meta-analyses confirmed the high diagnostic performance of TVS in diagnosing rectosigmoid endometriosis. The presence of “soft markers” (negative sliding sign and kissing ovaries) facilitates the diagnosis of rectosigmoid endometriosis. Enhanced TVS (rectal water-contrast transvaginal ultrasonography, sonovaginography, and tenderness-guided transvaginal ultrasonography) does not improve the performance of TVS in diagnosing rectosigmoid endometriosis. These investigations however may be useful to ascertain the depth of infiltration of endometriosis in the intestinal wall or the presence of rectal stenosis. MRI has the same performance of TVS in diagnosing rectosigmoid endometriosis; however, it should be recommended as a second-line technique in the preoperative workup of patients with previous equivocal TVS findings.
... This can present as localized bladder wall thickening with irregular borders. While the imaging findings are varied, lesions are frequently isointense to the bladder wall on T2W images and contain T1W hyperintense foci [34,35]. When full thickness infiltration of the detrusor muscle is present, this typically resembles a mural mass projecting into the bladder lumen and may even resemble bladder carcinoma [36,37]. ...
... When full thickness infiltration of the detrusor muscle is present, this typically resembles a mural mass projecting into the bladder lumen and may even resemble bladder carcinoma [36,37]. As with endometriosis elsewhere, the lesions demonstrate delayed enhancement on post contrast images compared to the noninvaded segment of the detrusor, particularly when the fibrotic component predominates [34]. For surgical planning, the most important information is the depth of detrusor invasion, precise location of the bladder involvement, and its distance from the ureteral meata. ...
Endometriosis is a common gynecologic disorder characterized by the presence of ectopic endometrial tissue outside the endometrial cavity. Magnetic Resonance Imaging (MRI) has become a mainstay for diagnosis and staging of this disease. In the literature, significant heterogeneity exists in the descriptions of imaging findings and anatomic sites of involvement. The Society of Abdominal Radiology’s Endometriosis Disease-Focused Panel presents this consensus document to establish an MRI lexicon for endometriosis MRI evaluation and anatomic localization.
... In line with different publications, pelvic phased-array coils provide a higher signalto-noise-ratio (SNR) than body coils (21,22). Endocavitary coil could be added in conjunction with pelvic phased-array but drawbacks in terms of cost and acceptability limits its potential use (23)(24)(25). ...
... "Fiesta, Trufisp, Balanced-FFE" sequences) after intestinal opacification with warm water (MRColonography) may help to affirm rectosigmoid wall involvement. Some authors propose the use of endocavitary coil or T1 sequences with gadolinium injection to optimize diagnostic accuracy (23,25). In daily practice, the discomfort caused by the endocavitary coil in the context of symptomatic endometriosis makes its use highly questionable. ...
Endometriosis is a common gynecological condition of unknown etiology that mainly affects women of reproductive age. The commonest site of gastrointestinal endometriosis is the rectosigmoid colon. Involvement of the sigmoid, cecum, appendix and small bowel are less common but one third of rectosigmoid endometriosis is associated with right-sided extra-pelvic bowel endometriosis. Intestinal endometriosis represents one of the most severe forms of deep endometriosis.
MRI is recommended as a second-line technique in the preoperative workup of deep endometriosis, especially for gastrointestinal endometriosis. An optimal MRI protocol is required for a complete mapping of endometriotic lesions. MRI could be used as a triage test in the diagnosis of rectosigmoid colon endometriosis. MRI enterography should be additionally performed requiring a specific additional MRI protocol for the evaluation of multicentric intestinal endometriotic lesions.
Except other imaging techniques, the aim of this chapter is to expose indications for MRI, technical requirements, patient preparation, MRI protocols and criteria for the diagnosis of intestinal endometriosis.
... Both body phased array coils and endorectal coils have been shown to be successful in diagnosing endometriosis. When compared to phased array coils alone, studies have shown improved detection of endometriosis utilizing a combination of an endorectal coil and a phased array coil [25][26][27]. Nevertheless, endorectal coil utilization results in an increase in cost, both in terms of the coil itself and as a result of the increased time and personnel needed for its placement. ...
Endometriosis is a common entity causing chronic pain and infertility in women. The gold standard method for diagnosis is diagnostic laparoscopy, which is invasive and costly. MRI has shown promise in its ability to diagnose endometriosis and its efficacy for preoperative planning. The Society of Abdominal Radiology established a Disease-Focused Panel (DFP) to improve patient care for patients with endometriosis. In this article, the DFP performs a literature review and uses its own experience to provide technical recommendations on optimizing MRI Pelvis for the evaluation of endometriosis.
... Pelvic MR, when tailored for the evaluation of endometriosis, is highly accurate for the identification and localization of endometriomas and DIE lesions [11,[13][14][15][16][17][18]. Referral centers for endometriosis use pelvic MR as a tool to identify, localize, and "map" the extent of disease for staging and treatment planning [19]. ...
Endometriosis is a chronic, multifocal disease, which can lead to pain or subfertility. Treatments are tailored toward the therapeutic goals of the individual patient; either to improve a specific pain symptom or optimize fertility. Management of endometriosis is complex, and best implemented by a comprehensive, multidisciplinary team of physicians and health care providers. The role of the radiologist in the management of endometriosis is becoming increasingly important as more centers move toward utilizing female pelvic MR studies to diagnose, delineate or follow endometriosis lesions. The radiologist must communicate pertinent, actionable findings from these studies in a manner that is clear and concise. Structured radiologic reports (SRR) add value in that they provide organized, clear, and comprehensive information from imaging studies, ensuring reports include essential items required for decision-making. In this paper, we review our MR imaging protocol and present the structured radiologic report implemented at our institution by our multidisciplinary endometriosis care team. Imaging features of endometriosis at each site specified in the structured report are summarized. The importance of each element included in the structured report from a management perspective is highlighted.
... The readers were asked to localize the identified lesions as follows: endometriomas of the right or left ovary, DPE lesions of the posterior pelvic compartment including the pouch of Douglas, the retrocervical region, and the uterosacral ligaments or the anterior compartment including lesions of the vesicouterine pouch and the round ligaments. The readers also evaluated bladder and ureteral invasion as described in the literature (8,10,13). The invasion of the rectosigmoid colon was also reported if it concerned at least the muscularis. ...
... Saba et al (22) in a paper examining the role of clinical information in the interpretation of MRI for endometriosis study the performances of radiologists with experience varying between 13,9,8, and 3 years. Although this study did not aim to compare the performance of radiologists, it seems that the authors found no significant differences between them. ...
Purpose
The purpose of this study was to investigate the impact of radiologist experience on diagnostic performance of pelvic magnetic resonance imaging (MRI) for the evaluation of endometriomas and different localisations of deep pelvic endometriosis (DPE).
Materials and methods
In this prospective study all pelvic MRI examinations performed for pelvic endometriosis from December 2016 to August 2017 were evaluated by readers with different experience levels; junior resident (0–6 weeks of experience in female imaging), senior resident (7–24 weeks), fellow (6–24 months), and expert (10 years) in female imaging for the presence of endometriomas and DPE. Their evaluations were compared with surgery confirmed with pathology. Diagnostic performances of readers with different levels of experience were studied by the means of receiving operating characteristic curves and areas under the curve (AUC) were compared with the ones of the expert reader.
Results
Of 174 patients evaluated, the standard of reference was available for 59, consisting the final population of the study. The AUC for endometriomas, DPE for the posterior and anterior pelvic compartment, for rectosigmoid DPE and for overall evaluation were 0.983, 0.921, 0.615, 0.862, and 0.914 for the expert reader, 0.966 (p = 0.178), 0.805 (p = 0.001), 0.605 (p = 0.91), 0.872 (p = 0.317), and 0.849 (p = 0.0009) for the fellow level, 0.877 (p = 0.002), 0.757 (p < 0.001), 0.585 (p = 0.761), 0.744 (p = 0.239), and 0.787 (p = < 0.001) for the senior resident level and 0.861 (p = 0.177), 0.649 (p < 0.001), 0.648 (p = 0.774), 0.862 (p = 1), and 0.721 (p < 0.001) for the junior resident level.
Conclusions
According to our results, interpretation of pelvic MRI for DPE should be performed by specialists as; even the performance of radiologists with up to 2 years of experience in female imaging was statistically inferior to that of experts.
... MRI is an accurate and non-invasive technique usually used as a secondline examination for the diagnosis of adenomyosis (Bazot and Darai, 2018). The sensitivity and specificity of MRI in diagnosing adenomyosis range from 88 to 93% and 67 to 91%, respectively (Kinkel et al., 1999;Dueholm and Lundorf, 2007;Champaneria et al., 2010;Exacoustos et al., 2014;Shwayder and Sakhel, 2014;Graziano et al., 2015). ...
Background:
Adenomyosis is a benign uterine disorder where endometrial glands and stroma are pathologically demonstrated within the uterine myometrium. The pathogenesis involves sex steroid hormone abnormalities, inflammation, fibrosis and neuroangiogenesis, even though the proposed mechanisms are not fully understood. For many years, adenomyosis has been considered a histopathological diagnosis made after hysterectomy, classically performed in perimenopausal women with abnormal uterine bleeding (AUB) or pelvic pain. Until recently, adenomyosis was a clinically neglected condition. Nowadays, adenomyosis may also be diagnosed by non-invasive techniques, because of imaging advancements. Thus, a new epidemiological scenario has developed with an increasing number of women of reproductive age with ultrasound (US) or magnetic resonance imaging (MRI) diagnosis of adenomyosis. This condition is associated with a wide variety of symptoms (pelvic pain, AUB and/or infertility), but it is also recognised that some women are asymptomatic. Furthermore, adenomyosis often coexists with other gynecological comorbidities, such as endometriosis and uterine fibroids, and the diagnostic criteria are still not universally agreed. Therefore, the diagnostic process for adenomyosis is challenging.
Objective and rationale:
We present a comprehensive review on the diagnostic criteria of adenomyosis, including clinical signs and symptoms, ultrasound and MRI features and histopathological aspects of adenomyotic lesions. We also briefly summarise the relevant theories on adenomyosis pathogenesis, in order to provide the pathophysiological background to understand the different phenotypes and clinical presentation. The review highlights the controversies of multiple existing criteria, summarising all of the available evidences on adenomyosis diagnosis. The review aims also to underline the future perspective for diagnosis, stressing the importance of an integrated clinical and imaging approach, in order to identify this gynecological disease, so often underdiagnosed.
Search methods:
PubMed and Google Scholar were searched for all original and review articles related to diagnosis of adenomyosis published in English until October 2018.
Outcomes:
The challenge in diagnosing adenomyosis starts with the controversies in the available pathogenic theories. The difficulties in understanding the way the disease arises and progresses have an impact also on the specific diagnostic criteria to use for a correct identification. Currently, the diagnosis of adenomyosis may be performed by non-invasive methods and the clinical signs and symptoms, despite their heterogeneity and poor specificity, may guide the clinician for a suspicion of the disease. Imaging techniques, including 2D and 3D US as well as MRI, allow the proper identification of the different phenotypes of adenomyosis (diffuse and/or focal). From a histological point of view, if the diagnosis of diffuse adenomyosis is straightforward, in more limited disease, the diagnosis has poor inter-observer reproducibility, leading to extreme variations in the prevalence of disease. Therefore, an integrated non-invasive diagnostic approach, considering risk factors profile, clinical symptoms, clinical examination and imaging, is proposed to adequately identify and characterise adenomyosis.
Wider implications:
The development of the diagnostic tools allows the physicians to make an accurate diagnosis of adenomyosis by means of non-invasive techniques, representing a major breakthrough, in the light of the clinical consequences of this disease. Furthermore, this technological improvement will open a new epidemiological scenario, identifying different groups of women, with a dissimilar clinical and/or imaging phenotypes of adenomyosis, and this should be object of future research.
... Endometriotic lesions in the bowel often harbor histological content other than hemorrhage-that is fibrosis, leading to variability in the MRI signal pattern. In addition, lesions more than 8 cm superior to the anal margin may be missed even when using endorectal coils that are required for optimizing image quality [7]. On the other hand, CT may have several advantages over MRI in this regard (i.e., shorter acquisition time, wider coverage). ...
... respectively, with an area under the HSROC curve of 0.98 (95% CI, 0.96-0.99). Although CT is not considered to be an initial diagnostic modality (as compared with MRI) in patients suffering from endometriosis, due to its inherent limitation of ionizing radiation which may be more problematic in women in the reproductive ages, the results from our study suggest that CT could play an important role in the diagnostic process of bowel endometriosis when considering the following issues: (1) despite the high accuracy of MRI for diagnosing endometriotic lesions in general, it shows poorer performance for bowel lesions, especially more than 8 cm superior to the anal margin [7]; (2) acquisition of optimal MRI for bowel endometriosis requires endorectal coils which may not be easily tolerated by some patients [1]; (3) some patients may not be able to undergo MRI examinations for various reasons (i.e., claustrophobia, metallic implants, and etc.); and (4) CT has some advantages over MRI in that the examination time is significantly shorter and CT has greater spatial resolution. Still, as there is only a limited number of studies assessing the diagnostic performance of CT for bowel endometriosis-that is, only 12 studies included in this meta-analysis-and future studies may be needed for validation. ...
Purpose:
To perform a systematic review and meta-analysis regarding the performance of CT for diagnosis of bowel endometriosis.
Materials and methods:
Pubmed and EMBASE were systematically searched up to March 28, 2019. Diagnostic accuracy studies using CT for diagnosis of bowel endometriosis using laparoscopy followed by histopathology as the reference standard were included. Methodological quality of the included studies was evaluated using Quality Assessment of Diagnostic Accuracy Studies-2. Sensitivity and specificity were pooled using hierarchical summary receiver operating modelling. Meta-regression analysis was done to explore heterogeneity.
Results:
Twelve studies (1091 patients) were included. Pooled sensitivity and specificity were 0.92 (95% confidence interval [CI], 0.83-0.97) and 0.95 (95% CI, 0.88-0.98), respectively. Substantial heterogeneity was present: I2 = 92.38% for sensitivity and 89.09% for specificity. Deeks' asymmetry test suggested publication bias (p = 0.04). At meta-regression analysis, history of prior surgery for endometriosis was the only significant factor affecting heterogeneity (p < 0.01). Specifically, studies that included patients with such history demonstrated significantly greater specificity than studies that did not (0.95 [95% CI, 0.91-1.00] vs 0.75 [95% CI, 0.43-1.00]).
Conclusions:
CT shows excellent performance in the diagnosis of bowel endometriosis. Due to small number of included studies and publication bias, further studies may be needed to validate these results.
