Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
European Radiology
Published in: European Radiology 1/2014

01-01-2014 | Magnetic Resonance

Diffusion tensor imaging and tractography to evaluate sacral nerve root abnormalities in endometriosis-related pain: A pilot study

Authors: L. Manganaro, M. G. Porpora, V. Vinci, S. Bernardo, P. Lodise, P. Sollazzo, M. E. Sergi, M. Saldari, G. Pace, G. Vittori, C. Catalano, P. Pantano

Published in: European Radiology | Issue 1/2014

Login to get access

Abstract

Objective

To prospectively evaluate microstructural abnormalities in sacral nerve roots in women affected by chronic pelvic pain associated with endometriosis.

Methods

We enrolled 30 women with an ultrasound diagnosis of endometriosis and moderate-severe chronic pelvic pain; 10 age-matched healthy women comprised the control group. All subjects underwent 3 T magnetic resonance imaging (MRI), including diffusion tensor imaging (DTI); the sacral roots were reconstructed by post-processing the DTI data with dedicated software. Mean fractional anisotropy (FA) values in the S1, S2 and S3 roots were quantified. Analysis of FA values was performed by two radiologists in order to evaluate the interobserver agreement.

Results

The sacral nerve roots in healthy subjects were clearly visualised. Most of the patients with endometriosis displayed abnormalities of S1, S2 and S3 bilaterally at tractography, including an irregular and disorganised appearance. FA values in the S1, S2 and S3 roots were significantly lower in patients than in controls (P < 0.0001, <0.05 and <0.02, respectively) for both observers. No significant difference was found between observers.

Conclusion

DTI with tractography is a non-invasive means of detecting changes in the microarchitecture of the sacral nerve roots. It can qualitatively and quantitatively reveal sacral root abnormalities in patients with endometriosis-associated pain.

Key Points

• MRI is increasingly used for endometriosis and chronic pelvic pain (CPP).
• Magnetic resonance tractography can demonstrate microarchitectural abnormalities in sacral nerve roots.
• Tractography shows altered microstructure of sacral roots affected by endometriosis and CPP.
• S1–S3 fractional anisotropy values are lower in endometriosis than in healthy women.
• Sacral nerve root alteration may explain the nature of endometriosis-related CPP.
Literature
1.
Eskenazi B, Warner ML (1997) Epidemiology of endometriosis. Obstet Gynecol Clin North Am 24:235–258PubMedCrossRef
2.
Meuleman C, Vandenabeele B, Fieuws S et al (2009) High prevalence of endometriosis in infertile women with normal ovulation and normospermic partners. Fertil Steril 92:68–74PubMedCrossRef
3.
Ferrero S, Arena E, Morando A et al (2010) Prevalence of newly diagnosed endometriosis in women attending the general practitioner. Int J Gynaecol Obstet 110:203–207PubMedCrossRef
4.
Fauconnier A, Chapron C, Dubuisson JB et al (2002) Relation between pain symptoms and the anatomic location of deep infiltrating endometriosis. Fertil Steril 78:719–726PubMedCrossRef
5.
Murphy PG, Ramer MS, Borthwick L et al (1999) Endogenous interleukin-6 contributes to hypersensitivity to cutaneous stimuli and changes in peptides associated with chronic nerve constriction in mice. Eur J Neurosci 11:2243–2253PubMedCrossRef
6.
Porpora MG, Koninckx PR, Piazze J et al (1999) Correlation between endometriosis and pelvic pain. J Am Assoc Gynecol Laparosc 6:429–434PubMedCrossRef
7.
Howard FM (2000) Endometriosis and endosalpingiosis. In: Howard FM, Perry CP, Carter JE, El-Minawi AM, Li RZ (eds) Pelvic pain, diagnosis and management. Lippincott Williams & Wilkins, Philadelphia, pp 125–150
8.
Solnik MJ (2006) Chronic pelvic pain and endometriosis in adolescents. Curr Opin Obstet Gynecol 18:511–518PubMedCrossRef
9.
Porpora MG, Pallante D, Ferro A et al (2010) Pain and ovarian endometrioma recurrence after laparoscopic treatment of endometriosis: a long-term prospective study. Fertil Steril 93:716–721PubMedCrossRef
10.
Stratton P, Berkley KJ (2011) Chronic pelvic pain and endometriosis: translational evidence of the relationship and implications. Hum Reprod Update 17:327–346PubMedCentralPubMedCrossRef
11.
Berkley KJ, Dmitrieva N, Curtis KS et al (2004) Innervation of ectopic endometrium in a rat model of endometriosis. Proc Natl Acad Sci U S A 27:11094–11098CrossRef
12.
13.
Barena de arellano M, Arnold J et al (2011) Influence of Nerve Growth Factor in Endometriosis-associated Symptoms. Reprod Sciences 18:1202–1210CrossRef
14.
Tokushige N, Markham R, Russell P, Fraser IS (2006) High density of small nerve fibres in the functional layer of the endometrium in women with endometriosis. Hum Reprod 21:782–787PubMedCrossRef
15.
Check JH (2011) Chronic pelvic pain syndromes–traditional and novel therapies: part I surgical therapy. Clin Exp Obstet Gynecol 38:10–13PubMed
16.
Cheong Y, William SR (2006) Chronic pelvic pain: aetiology and therapy. Best Pract Res Clin Obstet Gynaecol Oct 20:695–711CrossRef
17.
Mori S, Zhang J (2006) Principles of diffusion tensor imaging and its applications to basic neuroscience research. Neuron 51:527–539PubMedCrossRef
18.
Basser PJ, Pajevic S, Pierpaoli C et al (2000) In vivo fiber tractography using DT-MRI data. Magn Reson Med 44:625–632PubMedCrossRef
19.
Mori S, van Zijl PC (2002) Fiber tracking: principles and strategies - a technical review. NMR Biomed 15:468–480PubMedCrossRef
20.
Finley DS, Ellingson BM, Natarajan S et al (2012) Diffusion tensor magnetic resonance tractography of the prostate: Feasibility for mapping periprostatic fibers. Urology 0:219–223CrossRef
21.
Van der Jagt PK, Dik P, Froeling M et al (2012) Architectural configuration and microstructural properties of the sacral plexus: A diffusion tensor MRI and fiber tractography study. Neuroimage 62:1792–1799PubMedCrossRef
22.
Takaso M, Aoki Y, Toyone T et al (2011) Quantitative evaluation and visualization of lumbar foraminal nerve root entrapment by using diffusion tensor imaging: preliminary results. AJNR Am J Neuroradiol 32:1824–1829PubMedCrossRef
23.
Manganaro L, Vittori G, Vinci V et al (2012) Beyond laparoscopy: 3-T magnetic resonance imaging in the evaluation of posterior cul-de-sac obliteration. Magn Reson Imaging 30:1432–1438PubMedCrossRef
24.
Manganaro L, Fierro F, Tomei A et al (2012) Feasibility of 3.0T pelvic MR imaging in the evaluation of endometriosis. Eur J Radiol 81:1381–1387PubMedCrossRef
25.
Eguchia Y, Ohtoria S, Oritaa S et al (2011) Quantitative evaluation and visualization of lumbar foraminal nerve root entrapment by using diffusion tensor imaging: Preliminary results. AJNR Am J Neuroradiol 32:1824–1829CrossRef
26.
Balbi V, Budzik JF, Duhamel A et al (2011) Tractography of lumbar nerve roots: Initial results. Eur Radiol 21:1153–1159PubMedCrossRef
27.
28.
Skorpil M, Karlsson M, Nordell A (2012) Peripheral nerve diffusion tensor imaging. Magn Reson Imaging 22:743–745CrossRef
29.
Meek MF, Stenekes MW, Hoogduin HM et al (2006) In vivo three-dimensional reconstruction of human median nerves by diffusion tensor imaging. Exp Neurol 198:479–482PubMedCrossRef
30.
Ohana M, Moser T, Meyer N et al (2012) 3T tractography of the median nerve: Optimisation of acquisition parameters and normative diffusion values. Diagn Interv Imaging 93:775–784PubMedCrossRef
31.
Metadata
Title
Diffusion tensor imaging and tractography to evaluate sacral nerve root abnormalities in endometriosis-related pain: A pilot study
Authors
L. Manganaro
M. G. Porpora
V. Vinci
S. Bernardo
P. Lodise
P. Sollazzo
M. E. Sergi
M. Saldari
G. Pace
G. Vittori
C. Catalano
P. Pantano
Publication date
01-01-2014
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 1/2014
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-013-2981-0

Other articles of this Issue 1/2014

European Radiology 1/2014 Go to the issue

Computed Tomography

Incidence of contrast-induced nephropathy in hospitalised patients with cancer

Cardiac

High-pitch dual-source CT coronary angiography with low volumes of contrast medium

Computed Tomography

Evaluation of a method for improving the detection of hepatocellular carcinoma

Musculoskeletal

MRI differentiation of low-grade from high-grade appendicular chondrosarcoma

Computed Tomography

Image noise-based dose adaptation in dynamic volume CT of the heart: dose and image quality optimisation in comparison with BMI-based dose adaptation

Head and Neck

Head and neck tumours: combined MRI assessment based on IVIM and TIC analyses for the differentiation of tumors of different histological types