Top

European Radiology

Published in:

01-04-2010 | Urogenital

Utility of vaginal and rectal contrast medium in MRI for the detection of deep pelvic endometriosis

Authors: M. Chassang, S. Novellas, C. Bloch-Marcotte, J. Delotte, O. Toullalan, A. Bongain, P. Chevallier

Published in: European Radiology | Issue 4/2010

Abstract

Objective

To study the sensitivity of MRI performed utilising vaginal and rectal opacification with ultrasound gel in the detection of deep pelvic endometriosis.

Material and methods

This was a prospective monocentric study. All patients evaluated by the gynaecologist for pelvic pain, endometriosis or infertility were included. Axial and sagittal T2-weighted images were performed both with and without vaginal and rectal opacification with ultrasound gel. Three radiologists, all blinded, interpreted the images with a minimum of 15 days between the two readings. MRI performance with and without vaginal and rectal opacification was evaluated by calculating sensitivity, specificity and both positive and negative predictive values.

Results

Seventy-eight patients were included. Among these, 31 patients had deep pelvic endometriosis of which 24 were confirmed by laparoscopy. Seventy-six locations of deep pelvic endometriosis were discovered on MRI. For the three reviewers there was a significant improvement in sensitivity between pre- and post-contrast MRI (p < 0.0002).

Conclusion

Opacification of the vagina and rectum significantly improved the sensitivity of MRI for the detection of deep pelvic endometriosis by expanding the vagina and rectum, thus allowing better delineation of the pelvic organs. This was especially apparent for lesions localised to the vagina and rectovaginal septum.

Koninckx PR, Meuleman C, Demeyere S, Lesaffre E, Cornillie FJ (1991) Suggestive evidence that pelvic endometriosis is a progressive disease, whereas deeply infiltrating endometriosis is associated with pelvic pain. Fertil Steril 55:759–765PubMed

Chapron C, Fauconnier A, Vieira M et al (2003) Anatomical distribution of deeply infiltrating endometriosis: surgical implications and proposition for a classification. Hum Reprod 18:157–161CrossRefPubMed

Kataoka ML, Togashi K, Yamaoka T et al (2005) Posterior cul-de-sac obliteration associated with endometriosis: MR imaging evaluation. Radiology 234:815–823CrossRefPubMed

Ford J, English J, Miles WA, Giannopoulos T (2004) Pain, quality of life and complications following the radical resection of rectovaginal endometriosis. BJOG 111:353–356CrossRefPubMed

Hollett-Caines J, Vilos GA, Penava DA (2003) Laparoscopic mobilization of the rectosigmoid and excision of the obliterated cul-de-sac. J Am Assoc Gynecol Laparosc 10:190–194CrossRefPubMed

Abbott JA, Hawe J, Clayton RD, Garry R (2003) The effects and effectiveness of laparoscopic excision of endometriosis: a prospective study with 2–5 year follow-up. Hum Reprod 18:1922–1927CrossRefPubMed

Redwine DB, Wright JT (2001) Laparoscopic treatment of complete obliteration of the cul-de-sac associated with endometriosis: long-term follow-up of en bloc resection. Fertil Steril 76:358–365CrossRefPubMed

Chopin N, Vieira M, Borghese B et al (2005) Operative management of deeply infiltrating endometriosis: results on pelvic pain symptoms according to a surgical classification. J Minim Invasive Gynecol 12:106–112CrossRefPubMed

Zanardi R, Del Frate C, Zuiani C, Bazzocchi M (2003) Staging of pelvic endometriosis based on MRI findings versus laparoscopic classification according to the American Fertility Society. Abdom Imaging 28:733–742CrossRefPubMed

10.

Roy C, Balzan C, Thoma V, Sauer B, Wattiez A, Leroy J (2009) Efficiency of MR imaging to orientate surgical treatment of posterior deep pelvic endometriosis. Abdom Imaging 34:251–259CrossRefPubMed

11.

Kinkel K, Frei KA, Balleyguier C, Chapron C (2006) Diagnosis of endometriosis with imaging: a review. Eur Radiol 16:285–298CrossRefPubMed

12.

Del Frate C, Girometti R, Pittino M, Del Frate G, Bazzocchi M, Zuiani C (2006) Deep retroperitoneal pelvic endometriosis: MR imaging appearance with laparoscopic correlation. Radiographics 26:1705–1718CrossRefPubMed

13.

Bazot M, Darai E, Hourani R et al (2004) Deep pelvic endometriosis: MR imaging for diagnosis and prediction of extension of disease. Radiology 232:379–389CrossRefPubMed

14.

Jarlot C, Anglade E, Paillocher N, Moreau D, Catala L, Aubé C (2008) MR imaging features of deep pelvic endometriosis: correlation with laparoscopy. J Radiol 89:1745–1754CrossRefPubMed

15.

Ha HK, Lim YT, Kim HS, Suh TS, Song HH, Kim SJ (1994) Diagnosis of pelvic endometriosis: fat-suppressed T1-weighted vs conventional MR images. Am J Roentgenol 163:127–131

16.

Mondot L, Novellas S, Senni M et al (2006) Pelvic prolapse: static and dynamic MRI. Abdom Imaging 32:775–783CrossRef

17.

Akata D, Kerimoglu U, Hazirolan T et al (2005) Efficacy of transvaginal contrast-enhanced MRI in the early staging of cervical carcinoma. Eur Radiol 15:1727–1733CrossRefPubMed

18.

Van Hoe L, Vanbeckevoort D, Oyen R, Itzlinger U, Vergote I (1999) Cervical carcinoma: optimized local staging with intravaginal contrast-enhanced MR imaging—preliminary results. Radiology 213:608–611PubMed

19.

Urban M, Rosen HR, Hölbling N et al (2000) MR imaging for the preoperative planning of sphincter-saving surgery for tumors of the lower third of the rectum: use of intravenous and endorectal contrast materials. Radiology 214:503–508PubMed

20.

van Leeuwen E (1990) Between scientific application and therapy: the ethical consideration. Dev Biol Stand 71:161–170PubMed

21.

Brown MA, Mattrey RF, Stamato S (2005) MRI of the female pelvis using vaginal gel. AJR 185:1221–1227CrossRefPubMed

22.

Takeuchi H, Kuwatsuru R, Kitade M et al (2005) A novel technique using magnetic resonance imaging jelly for evaluation of rectovaginal endometriosis. Fertil Steril 83:442–447CrossRefPubMed

23.

Kikuchi I, Takeuchi H, Kuwatsuru R et al (2009) Diagnosis of complete cul-de-sac obliteration (CCDSO) by the MRI jelly method. J Magn Reson Imaging 29:365–370CrossRefPubMed

24.

Bazot M, Nassar J, Daraï E et al (2005) Value of sonography and MR imaging for the evaluation of deep pelvic endometriosis. J Radiol 86:461–467CrossRefPubMed

25.

Abrao MS, Gonçalves MO, Dias JA Jr, Podgaec S, Chamie LP, Blasbalg R (2007) Comparison between clinical examination, transvaginal sonography and magnetic resonance imaging for the diagnosis of deep endometriosis. Hum Reprod 22:3092–3097CrossRefPubMed

26.

Chapron C, Dubuisson JB, Pansini V et al (2002) Routine clinical examination is not sufficient for diagnosing and locating deeply infiltrating endometriosis. J Am Assoc Gynecol Laparosc 9:115–119CrossRefPubMed

27.

Bazot M, Thomassin I, Hourani R, Cortez A, Darai E (2004) Diagnostic accuracy of transvaginal sonography for deep pelvic endometriosis. Ultrasound Obstet Gynecol 24:180–185CrossRefPubMed

Title: Utility of vaginal and rectal contrast medium in MRI for the detection of deep pelvic endometriosis
Authors: M. Chassang
S. Novellas
C. Bloch-Marcotte
J. Delotte
O. Toullalan
A. Bongain
P. Chevallier
Publication date: 01-04-2010
Publisher: Springer-Verlag
Published in: European Radiology / Issue 4/2010
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-009-1627-8

At a glance: The STEP trials

Springer Medicine

Utility of vaginal and rectal contrast medium in MRI for the detection of deep pelvic endometriosis

Abstract

Objective

Material and methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Material and methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 4/2010

18F-FDG-PET/CT in the diagnosis of paraneoplastic neurological syndromes: a retrospective analysis

Assessment of lung development in isolated congenital diaphragmatic hernia using signal intensity ratios on fetal MR imaging

Radiofrequency ablation of hepatic tumours: effect of post-ablation margin on local tumour progression

Interactive dedicated training curriculum improves accuracy in the interpretation of MR imaging of prostate cancer

Letter to the Editor re: “Carotid stenting through the right brachial approach for left internal carotid artery stenosis and bovine aortic arch configuration”

Correlation of regional distribution and morphological pattern of calcification at CT coronary artery calcium scoring with non-calcified plaque formation and stenosis