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Abdominal Radiology
Published in: Abdominal Radiology 4/2012

Open Access 01-08-2012

Deep infiltrating endometriosis of the bowel: MR imaging as a method to predict muscular invasion

Authors: Milou P. H. Busard, Lisette E. E. van der Houwen, Maaike C. G. Bleeker, Indra C. Pieters van den Bos, Miguel A. Cuesta, Cornelis van Kuijk, Velja Mijatovic, Peter G. A. Hompes, Jan Hein T. M. van Waesberghe

Published in: Abdominal Radiology | Issue 4/2012

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Abstract

Purpose

To evaluate magnetic resonance (MR) imaging morphologic- and signal intensity abnormalities of deep infiltrating endometriosis (DIE) of the bowel wall and to assess its value in predicting depth and extent of bowel wall infiltration.

Materials and methods

This single-center study was performed in a tertiary referral center for endometriosis. All patients (n = 28) who underwent segmental bowel resection (2004–2010) were retrospectively studied. MR images were analyzed by two experienced readers independently (number of lesions, location, size, signal intensity, and depth of bowel wall infiltration) and this was correlated with histopathology.

Results

The sensitivity, specificity, positive and negative predictive values, and accuracy for diagnosis of endometriosis infiltrating the muscular layer of the bowel were 100%, 75%, 96%, 100%, and 96%, respectively. The inter-rater agreement was 0.84. “Fan shaped” configurations with hypointensity on T2- and T1-weighted imaging were characteristic for thickening of indigenous smooth muscle and smooth muscle hyperplasia at histopathology, as a consequence of infiltration by endometriosis. Thickening of the (sub)mucosa corresponded to edema with or without infiltration of endometriosis.

Conclusion

MR imaging at 1.5 Tesla is useful to predict muscular infiltration of the bowel in endometriosis, whereas it is of limited value in diagnosis of (sub)mucosal infiltration.
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Metadata
Title
Deep infiltrating endometriosis of the bowel: MR imaging as a method to predict muscular invasion
Authors
Milou P. H. Busard
Lisette E. E. van der Houwen
Maaike C. G. Bleeker
Indra C. Pieters van den Bos
Miguel A. Cuesta
Cornelis van Kuijk
Velja Mijatovic
Peter G. A. Hompes
Jan Hein T. M. van Waesberghe
Publication date
01-08-2012
Publisher
Springer-Verlag
Published in
Abdominal Radiology / Issue 4/2012
Print ISSN: 2366-004X
Electronic ISSN: 2366-0058
DOI
https://doi.org/10.1007/s00261-011-9790-1

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