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Deep endometriosis with rectal infiltrative lesion ( arrowheads ). Despite the increased background noise, LR- T2 image ( a ) is of good quality compared to HR-T2 image ( b ), which is affected by motion artefacts
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Objective:
To compare the capabilities of standard pelvic MRI with low-resolution pelvic MRI using fast breath-hold sequences to evaluate deep infiltrating endometriosis (DIE).
Methods:
Sixty-eight consecutive women with suspected DIE were studied with pelvic MRI. A double-acquisition protocol was carried out in each case. High-resolution (HR)-M...
Context in source publication
Context 1
... quality and diagnostic confidence between HR-MRI and LR-MRI were compared using the Wilcoxon rank test. Sensitivity, specificity, negative (NPV) and positive (PPV) predictive values, and diagnostic accuracy of both radiologists were calculated for each site examined, with laparoscopy considered as the gold standard for diagnosis. The differences in sensitivities and specificities were analysed using the McNemar test as described by Hawass in 1997 [12]. Interobserver agreement was calculated with the Cohen ’ s kappa test. Statistical significance was set at p <0.05. Endometriosis was confirmed at laparoscopy in 57/68 women (84 %) DIE was observed in 48/57 (84 %) cases. Surgical intervention showed 25/57 (44 %) cases of USL involvement; 24/57 (42 %) cases of POD obliteration; 18 (32 %) nodules of the RVS; and 14/57 (25 %) colorectal endometriotic infiltrations. At surgery, lesion size ranged from 6 mm to 50 mm. No bladder or ureteral lesions were detected in this series. Laparoscopic findings of the remaining 11 patients were the following: mature teratoma in two cases, pelvic inflam- matory disease in three, haemorrhagic corpus luteum in three, and pelvic adhesions in three women. In all of these cases, MRI was able to provide the correct diagnostic information, ruling out deep endometriosis. Of the 14 patients with colorectal endometriosis, nine underwent segmental bowel resection, while four patients underwent nodulectomy of a small nodule. The average length of time for HR-MRI and LR-MRI examinations was 24 and 7 minutes, respectively. The evaluation of image quality and diagnostic confidence is summarized in Table 1. Of the total 68 patient examinations, HR-MRI image quality was considered good in 60 (88 %), sufficient in 6 (8 %), and poor in 2 (3 %) by R1, while R2 evaluated 62 (91 %) as good, 4 (6 %) as sufficient, and 2 (3 %) as poor (Fig. 1). LR images were considered good in 52 (76 %) cases, sufficient in 14 (21 %), and poor in 2 (3 %) cases by both R1 and R2. Diagnostic confidence for R1 was good in 64 (94 %) and sufficient in 4 (6 %) cases with HR- MRI and good in 60 (88 %) and sufficient in 8 (12 %) with LR-MRI. R2 rated diagnostic confidence as good in 62 (91 %), sufficient in 5 (7 %), and poor in 1 (2 %) with HR- MRI, and good in 58 (81 %), sufficient in 7 (15 %), and poor in 3 (4 %) cases with LR-MRI. Wilcoxon rank scores showed that image quality and diagnostic confidence were significantly higher for HR-MRI than LR-MRI for both R1 and R2 ( p <0.001). Overall and site-by-site sensitivity, specificity, PPV, NPV, and accuracy are detailed in Tables 2 and 3. The more experienced radiologist achieved higher accuracy values in the evaluation of all lesions using both HR-MRI (sensitivity 81 % vs. 73 %, specificity 95 % vs. 90 %, PPV 90 % vs. 81 %, NPV 90 % vs. 86 %, and accuracy 90 % vs. 84 %) and LR-MRI (sensitivity 81 % vs. 72 %, specificity 94 % vs. 88 %, PPV 88 % vs. 76 %, NPV 90 % vs. 85 %, and accuracy 89 % vs. 82 %). McNemar ’ s test did not demonstrate any significant difference in sensitivity or specificity for the radiologists with either HR or LR images (Figs. 2, and 3). The size of detected lesions ranged from 8 mm to 42 mm for R1 and from 9 mm to 45 mm for R2, with no difference between imaging protocols. False-negative cases were due to retroverted uterus in most cases and to the presence of plaque-like lesions without a nodular shape. Moreover, both readers failed to detect two 6 mm lesions (one rectal nodule and one right USL lesion). On the other hand, apparent thickening of USL, RVS, and rectal wall produced false-positive cases. Interobserver agreement was not significantly different between HR- MRI and LR-MRI (Table 4). In fact, kappa values demonstrated good agreement for the diagnosis of RVS, USL and POD involvement, but only moderate agreement for the diagnosis of rectal involvement, with accuracy significantly higher for R1 compared to R2. In this study, we compared the accuracy of standard HR-MRI and LR-MRI in the diagnosis of DIE, and showed excellent overall diagnostic results for LR-MRI. Notwithstanding the slightly better accuracy of the more experienced radiologist with both LR MRI - and HR-MRI protocols, statistical mea- sures of the performances (namely sensitivity, specificity, PPV, and NPV) were not different. Furthermore, interobserver agreement, which was good for the diagnosis of RVS, USL, and POD involvement and moderate for the diagnosis of intestinal lesions, did not change significantly when LR- MRI was used. The detection of endometriosis at radiological imaging is challenging, and pelvic mapping of deep infiltrating endometriotic lesions is of immeasurable value for planning patient care [13]. A proper evaluation requires knowledge of the pelvic anatomy and the tissue charac- teristics of deep infiltrating endometriotic lesions. These lesions consist of muscular hyperplasia surrounding foci of ectopic endometrial tissue. Their imaging features mainly reflect the predominant smooth muscle prolifera- tion and the fibrotic component, which often produces the appearance of a solid tumour-like mass with associated fibrosis, extending more than 5 mm from the peritoneal surface into adjacent structures [14]. A precise diagnosis of the presence, location, and extent of rectosigmoid endometriosis is required prior to surgery, primarily in order to discuss the surgical approach (nodulectomy or bowel resection) with the colorectal surgeon and to obtain informed consent from the patient [15, 16]. Nowadays, MRI is considered an ideal complement to ultrasound and physical examination because of its ability to explore the entire pelvis and to diagnose all associated lesions without radiological exposure [17, 18]. According to the American Fertility Society, staging of pelvic endometriosis based on MRI findings versus laparoscopic classification demonstrated higher accuracy in the detection of all deep pelvic sites of endometriosis, as well as provided accurate depiction of the extent of the disease for a complete lesion mapping before surgery [19, 20]. The standard MRI protocol presented in most papers is a high-resolution pelvic examination, which provides anatomic details to also visualize thin endometriotic changes. The major limitation of this protocol is its duration (24 minutes on average), which may result in decreased patient tolerance, especially in multiple follow-up studies. In fact, the need for additional sequences such as oblique axial images [21] or MR colonography, as suggested by our group in selected cases [11], can cause further lengthening of acquisition time (10 minutes on average), which is not well-accepted by the patients. In addition, high- resolution images may show artefacts due to bowel peristalsis, and consequently, a reduction in diagnostic accuracy [13]. Our results ...
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... Several studies have shown that MRI is the second, after ultrasound, best non-invasive method for analyzing endometriosis, with an overall sensitivity, for different disease sites of 90% (10). ...
... Several studies have shown that MRI is the second, after ultrasound, best non-invasive method for analyzing endometriosis, with an overall sensitivity, for different disease sites of 90% (10). ...
Background
To prospectively evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) for the planning of surgical treatment of deep pelvic endometriosis.Materials and Methods
From January 2020 to December 2021, we evaluated 72 patients with symptoms characteristic of endometriosis to plan appropriate surgical treatment. Sensitivity (Se), specificity (Sp), positive and negative predictive values (VPP/VPN), and the accuracy of MRI for the detection of deep pelvic endometriosis were calculated.ResultsSeventy-two patients (mean age, 35.5 years; range, 20–46 years) suspected of having pelvic endometriosis were recruited. Pelvic endometriosis was confirmed at pathologic examination in 56 (77.7%) of 72 patients. A total of 22 (39.3%) of 56 patients were subjected to video laparoscopy (VLS), and 16 (72.2%) of 22 were treated by surgery. Se, Sp, VPP, and VPN in intestinal endometriosis diagnosis were, respectively, 100%, 93.3%, 100%, and 87.5%, and diagnostic accuracy was 95.4%. MRI Se in ureteral endometriosis diagnosis was 50%, Sp 100%, VPP 100%, VPN 78%, and diagnostic accuracy 82%. MRI Se in endometrioma diagnosis was 92.3%, Sp 100%, VPP 100%, VPN 90%, and diagnostic accuracy 95.4%. MRI Se in rectum-vaginal septum (SRV) endometriosis diagnosis was 80%, Sp 100%, VPP 100% VPN 85.7%, and diagnostic accuracy 91%. The MRI Se in the diagnosis of endometriosis involving ULS was 100%, Sp 92.8%, VPP 89%, VPN 100%, and diagnostic accuracy 95.4%. Complete concordance results in a 100% accuracy for all calculated values in diagnosing bladder endometriosis localizations.ConclusionMR imaging demonstrates high accuracy in detecting deep pelvic endometriosis in specific locations. It allows the localization of deep pelvic lesions with highly fibrotic components that are hardly recognizable with other imaging methods and not visible with VLS.
... On MRI, adenomyoma presents as a heterogeneous lesion contained within the myometrial wall, not involving the JZ and the uterine serosa. On T2W sequences, it presents as a hypointense mass with ill-defined margins, showing internally small high-intensity cystic components or hemorrhagic cystic cavities >5 mm (hyperintense on T1W images) ( Figures 5 and 6) [39]. MRI is extremely accurate in discriminating the composition and location of an adenomyoma, features widely considered in the classification of Bazot et al. (2018), according to which three subtypes can be identified: (1) Intramural adenomyoma, represented by a poorly defined mass enclosed in the myometrial wall, which is in turn classified into two subgroups based on its content, i.e., solid intramural adenomyoma, containing only small cystic elements (hemorrhagic or not), and cystic intramural adenomyoma containing a hemorrhagic cystic cavity; (2) Submucosal adenomyoma, represented by a myometrial mass with poorly defined borders with small cystic elements which projects into the endometrial cavity; (3) Subserous adenomyoma, represented by a poorly defined mass with small cystic elements in the subserosal area. ...
... On MRI, adenomyoma presents as a heterogeneous lesion contained within the myometrial wall, not involving the JZ and the uterine serosa. On T2W sequences, it presents as a hypointense mass with ill-defined margins, showing internally small high-intensity cystic components or hemorrhagic cystic cavities >5 mm (hyperintense on T1W images) ( Figures 5 and 6) [39]. ...
Uterine adenomyosis is a common benign condition defined by the presence of heterotopic endometrial glands and stroma within the myometrium. Adenomyosis is often related to infertility and other adverse pregnancy outcomes. Modern imaging techniques allow the non-invasive diagnosis of adenomyosis and, in this framework, Magnetic Resonance Imaging (MRI) has assumed a central role due to its high diagnostic accuracy in the detection of adenomyosis. Currently, there is still a lack of international consensus on adenomyosis diagnostic criteria and classification, despite the fact that an agreed reporting system would promote treatment outcomes and research. This review aims to emphasize the important contribution of MRI to the diagnosis of adenomyosis and to highlight how, thanks to the great tissue differentiation provided by MRI, it is possible to identify the main direct (cystic component) and indirect (junctional zone features) signs of adenomyosis and to distinguish its various subtypes according to different MRI-based classifications. We also explored the main MRI criteria to identify the most common pitfalls and differential diagnoses of adenomyosis, whose features should be considered to avoid misdiagnosis.
... To date, there are only two studies in the literature that have partially addressed this question, adopting shorter protocols in pelvic MRI with employment of fast low-resolution sequences using single-shot T2 and fast breath-hold T1 images [10] and advanced three-dimensional volumetric sequences for the diagnosis of deep endometriosis compared to conventional methods [11]. ...
... The abbreviated protocol, in turn, consists in gaining 12 min of scanning time compared to the full protocol, allowing reduced waiting time for MRI. On pelvic evaluation, our findings are in line with those from Scardapane et al. study [10], when comparing the diagnostic accuracy of the standard MRI protocol with an MRI protocol using low resolution sequences (single-shot T2 and fast breath-hold T1) to identify deep endometriosis lesions. However, despite obtaining good results in the detection of most lesions with a shorter acquisition time, they dealt with lower image quality and lower diagnostic confidence as limitations, mainly due to the increased background noise and lower spatial resolution. ...
PurposeTo compare the performance of imaging interpretation, intra- and inter-reader agreement between an abbreviated (aMRI) and full (fMRI) MRI protocol for diagnosis of pelvic endometriosis.Methods
Seventy consecutive fMRI exams performed under suspicion of pelvic endometriosis were selected. Four radiologists (Rd) (1–10 years experience) independently evaluated presence/absence of endometriosis at 9 anatomic sites (AS). The readers evaluated aMRI (coronal T2 TSE volumetric images and axial T1 GRE fat-sat without contrast, extracted from fMRI) and fMRI protocols randomly, with at least 4 weeks interval between readings. The degree of confidence for diagnosis at each AS was evaluated with a 1–3 Likert Scale (1: low; 3: high). Intra- and inter-reader agreement between protocols were evaluated by kappa statistics and took reading experience into account. The gold standard for assessing the performance of imaging interpretation (sensitivity, specificity and accuracy) used a consensus reading of two other Rd (> 15 years experience).ResultsThere was no significant difference in the accuracy of imaging interpretation between the abbreviated (0.83–0.86) and full (0.83–0.87) protocols (p = 0.15). Intra-reader agreement between protocols ranged from substantial to almost perfect (0.74–0.96). A substantial inter-reader agreement was found for both protocols for readers with similar levels of experience (0.67–0.69) and in the global analysis (0.66 for both protocols). No difference was found in terms of degree of confidence between protocols, for all readers.Conclusion
An abbreviated MRI protocol for pelvic endometriosis provided an accuracy of interpretation comparable to that of a complete protocol, with similar degrees of confidence and reproducibility, regardless the level of experience.
... Because a poor correlation has been demonstrated between the symptoms and severity of lesions, some authors suggest a paradigmatic shift to a more clinical diagnostic approach based on the combination of symptoms, imaging findings and response to empiric treatment, even before any surgical confirmation [8]. In this scenario, transvaginal ultrasound, magnetic resonance imaging (MRI) and in some cases computed tomography (CT) play a fundamental role [9,10]. MRI, the imaging technique with the highest overall accuracy for assessing the extent of DIE, has high specificity for endometriotic foci, owing to its inherent soft-tissue resolution [11,12]. ...
... The diagnosis may be facilitated by the presence of ancillary findings such as a "mushroom cap" sign (Figs. 8,9) [54]. This sign can be visible in any of the plane of the space and represents the endometriotic nodule growing into a mushroom-like shape in the bowel wall, covered by a high intensity signal rim representing the normal mucosa and submucosal layer (Figs. ...
... This sign can be visible in any of the plane of the space and represents the endometriotic nodule growing into a mushroom-like shape in the bowel wall, covered by a high intensity signal rim representing the normal mucosa and submucosal layer (Figs. 7,8,9). ...
Endometriosis is an estrogen-dependent chronic disease affecting about 10% of reproductive-age women with symptoms like pelvic pain and infertility. Pathologically, it is defined by the presence of endometrial tissue outside the uterine cavity responsible for a chronic inflammatory process. For decades the diagnosis of endometriosis was based on surgical exploration and biopsy of pelvic lesions. However, laparoscopy is not a risk-free procedure with possible false negative diagnosis due to an underestimate of retroperitoneal structures such as ureters and nerves. For these reasons nowadays, the diagnosis of endometriosis is based on a noninvasive approach where clinical history, response to therapy and imaging play a fundamental role. Trans-vaginal ultrasound and magnetic resonance imaging are suitable for recognizing most of endometriotic lesions; nevertheless, their accuracy is strictly determined by operators’ experience and imaging technique. This review paper aims to make radiologists aware of the diagnostic possibilities of pelvic MRI and familial with the MR acquisition protocols and image interpretation for women with endometriosis.
... Deep infiltrating endometriosis is defined as > 5 mm deep infiltration of endometrial glands and stroma over the peritoneal surface and adjacent tissues that induce to smooth muscle proliferation and fibrous reaction. This process determines the formation of solid fibrotic nodules and plaques (49,50) where they appear markedly hypointense on T2-weighted images. ...
Introduction:
Endometriosis affects 10%-15% of women in reproductive age and may cause no-cyclic chronic pelvic pain, dysmenorrhea, dyspareunia, urinary tract symptoms, and it is frequently associated with infertility. The peak of incidence is between 24 and 29 years old and the clinical diagnosis of endometriosis is generally delayed by 6-7 years. Laparoscopy with surgical biopsies is the "gold standard" for the diagnosis of endometriosis, with histological verification of endometrial ectopic glands and/or stroma. However, nowadays two different non-invasive modalities are routinely used for a presumptive diagnosis: Transvaginal Ultrasound (TVUS) and Magnetic Resonance Imaging (MRI).
Evidence acquisition:
A structured search using PubMed was performed starting from October 2020 and including all relevant original and review articles published since 2000. The search used the following key word combinations: "Endometriosis MRI" AND "DIE and MRI" (45); "MRI endometriosis and Pelvic Pain" OR "Endometriosis and MRI technical development" (296). Ultimately, 87 articles were deemed relevant and used as the literature basis of this review.
Evidence synthesis:
TVUS represents the first imaging approach for endometriosis showing a good diagnostic performance but it is highly operator dependent. MRI is a second level examination often used in complex cases indeterminate after TVUS and in pre-operative planning. MRI is considered the best imaging technique for mapping endometriosis since it provides a more reliable map of deep infiltrating endometriosis than physical examination and transvaginal ultrasound. We have analyzed and described the main forms of endometriosis: adnexal endometriosis, adenomyosis, peritoneal implants and deep infiltrating endometriosis, showing their appearance in the two imaging modalities.
Conclusions:
Endometriosis is one of the most common gynecologic disorders correlated to chronic pelvic pain whose treatment is still today complex and controversial. In this context, MRI has become an important additional non-invasive tool to investigate cases of chronic pelvic pain related to deep infiltrating endometriosis (DIE) with or without neural involvement.
... In the case of cervical cancer: the planning is done on each individual axial slice and, assuming every structure is displayed over as many as 20 contiguous axial slices, contouring requires up to 140 manual delineation for each patient. This takes at least 12 min per tumor volume [21], 2 min per one OAR such as bladder and femur [22], and usually more than 2 min for OARs with complex shape such as anorectum. Furthermore, manual contouring is subject to intra-and inter-operator variability, the latter being the main source of uncertainty in treatment planning [23]. ...
Background
Manual contouring for radiation therapy planning remains the most laborious and time consuming part in the radiation therapy workflow. Particularly for cervical cancer, this task is complicated by the complex female pelvic anatomy and the concomitant dependence on ¹⁸F-labelled Fluorodeoxyglucose (FDG) positron emission tomography (PET) and magnetic resonance (MR) images. Using deep learning, we propose a new auto-contouring method for FDG-PET/MR based cervical cancer radiation therapy by combining the high level anatomical topography and radiological properties, to the low-level pixel wise deep-learning based semantic segmentation.
Materials/Methods
The proposed method: 1) takes advantage of PET data and left/right anatomical symmetry, creating sub-volumes that are centered on the structures to be contoured. 2) Uses a 3D shallow U-Net (sU-Net) model with an encoder depth of 2. 3) Applies the successive training of 3 consecutive sU-Nets in a feed forward strategy. 4) Employs, instead of the usual generalized dice loss function (GDL), a patch dice loss function (PDL) that takes into account the Dice similarity index (DSI) at the level of each training patch. Experimental analysis was conducted on a set of 13 PET/MR images was using a leave-one-out strategy.
Results
Despite the limited data availability, 5 anatomical structures - the gross tumor volume, bladder, anorectum, and bilateral femurs - were accurately (DSI = 0.78), rapidly (1.9 seconds/structure), and automatically delineated by our algorithm. Overall, PDL achieved a better performance than GDL and DSI was higher for organs at risk (OARs) with solid tissue (e.g. femurs) than for OARs with air-filled soft tissues (e.g. anorectum).
Conclusion
The presented workflow successfully addresses the challenge of auto-contouring in FDG-PET/MR based cervical cancer. It is expected to expedite the cervical cancer radiation therapy workflow in both, conventional and adaptive radiation therapy settings.
... However, the experience of the radiologist is essential considering that the average acquisition time for both high-and low-resolution MRI was twenty-four minutes. The values of specificity, sensitivity, and positive and negative predictive values (NPV/PPV) did not differ significantly, which is why both are considered valuable tools for detecting deep endometriosis extension [39]. Bermot et al. [40] investigate the detection performance of MRI of anterior pelvic endometriotic lesions, and while the two radiologists had an identical sensitivity (89.5%), the specificity value was as follows: 100% for the junior and 89.5% for the senior. ...
Background and objectives: Abdominal wall endometriosis, also known as scar endometriosis, is a rare condition that is becoming increasingly common. The recent rise in incidence is attributed primarily to the surge of cesarean births, figures that could be influenced in a positive manner considering the improvements brought towards the ultrasound diagnostic methods that have been made in recent years. Materials and Methods: Here we report the cases of two Caucasian women of 38- (G2P2) and 36-years old (G1P1), both subjected to an ultrasound examination due to a specific symptomatic panel reported during anamnesis. Independently of the current status, in the first patient, there were no reported symptom-specific associations with endometriosis, but she had a known history of mild hereditary thrombophilia; the second woman suffered from two conditions positively associated with endometriosis. Results: In both cases, abnormal structures were revealed, with the diagnostic(s) of endometriosis being histologically confirmed based on a set of features observed during the investigation. Conclusions: This paper aims to highlight the importance of reducing cesarean births and to consider the diagnosis of scar endometriosis in women with a history of obstetric or gynaecological surgeries who present with cyclic, recurrent abdominal pain.
... There is significant variability in the literature regarding the MRI protocols used to assess endometriosis (4,10,13,16,25,27,31,35,(48)(49)(50)(51). ...
... Hence, T2W MR sequences without fat-suppression technique are the best sequences to detect intestinal endometriosis (4). Most MRI studies are performed using at least two orthogonal 2D-T2W planes (4,10,13,16,25,27,31,35,(48)(49)(50)(51). Further studies are required to clarify the field-of-view used for the axial acquisition and which additional 2D-T2W MR plane should be used. ...
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.
... В настоящее время для пациентов с ХТБ не существует специального протокола МРТ. В большинстве случаев используется стандартный протокол МР-сканирования малого таза, включающий следующие импульсные последовательности: Т2-ВИ sag, T2-ВИ axial, T2-ВИ oblique, 2D T1-ВИ, 2D T1-ВИ FS [9][10][11][12][13]. Вопрос о необходимости использования последовательностей Т2* (SWI), DWI, DIXON, STIR, 3D SPACE и сочетания их с выше перечисленными остается открытым. ...
Objective . To optimize a pelvic and lower abdominal cavity MRI protocol in the diagnosis of chronic pelvic pain (CPP) in women. Material and methods . A total of 57 reproductive-aged women with complaints of CPP were examined. The first stage of all patients after clinical and laboratory examination for clinical indications was performed ultrasound of the pelvis and abdominal cavity with dopplerometry. In the second stage, all the patients underwent an MRI using the standard Protocol, and then a modified Protocol. The final diagnosis was based on the results of a comprehensive examination, which included a clinical and neurological examination, gynecological examination, pelvic and abdominal ultrasound, radiography of the ileosacral joints and lumbosacral spine, fibrocolonoscopy and laparoscopy with morphological examination of the operating material (according to indications). Results . Forty-six (81%) patients were found to have gynecological factors for the development of CPP; 16 (28%) had extragenital factors. The examination results were verified by the data of surgical intervention (n = 16 (28%)), hysteroscopy (n = 21 (37%)), and laparoscopy (n = 9 (16%)) with morphological examination of biopsy specimens or surgical material.Comparing with the standard pelvic MR protocol provided evidence for the high diagnostic value of the modified protocol statistically significantly (p < 0.05): 99.2% sensitivity and 99.6% specificity. Conclusion . The developed non-contrast 1.5T MRI protocol for the pelvis permits MR images of the pelvis and adjacent anatomical areas to be obtained during one study without increasing time expenditures and upgrading equipment and software. The use of the protocol makes it possible to improve the quality of radiation diagnosis of gynecological and extragenital diseases in CPP and to recommend that the protocol in combination with other clinical and instrumental studies be introduced in clinical practice.
