Article information
Abstract
Endometriosis is common in women of reproductive age; it can cause pelvic pain and infertility. It is important to diagnose endometriosis and to thoroughly evaluate its extension, especially when surgical treatment is being considered. Magnetic resonance imaging (MRI) with careful examination technique and interpretation enables more accurate and complete diagnosis and staging than ultrasonography, especially in cases of deep pelvic endometriosis. Furthermore, MRI can identify implants in sites that can be difficult to access in endoscopic or laparoscopic explorations.
In this article, we describe the appropriate MRI protocol for the study of pelvic endometriosis and the MRI signs of pelvic organ involvement. It is necessary to know the subtle findings and to look for them so we can ensure that they are not overlooked. We describe clinical grading systems for endometriosis and review the diagnostic efficacy of MRI in comparison with other imaging techniques and surgery.
Keywords:
Endometriosis
Magnetic resonance imaging
MRI
Pelvic pain
Resumen
La endometriosis es una afección frecuente en mujeres en edad reproductiva, que puede causar dolor pelviano e infertilidad. Es importante el diagnóstico correcto y evaluar de forma completa su extensión, especialmente cuando se plantea un tratamiento quirúrgico. La resonancia magnética (RM), con técnica de exploración e interpretación radiológica cuidadas, permite un diagnóstico y estadificación más precisos y completos que la ecografía, especialmente en la endometriosis pelviana profunda. Además, en RM se pueden identificar implantes en localizaciones de difícil acceso para exploraciones endoscópicas o laparoscópicas.
En este artículo describimos el protocolo de RM adecuado para estudiar la endometriosis pelviana, detallando la semiología en RM de la afectación en los órganos de la pelvis. Es necesario conocer y buscar hallazgos sutiles para evitar que pasen desapercibidos. Se describen sistemas de gradación clínica de la endometriosis y se revisa la eficacia diagnóstica de la RM comparada con otras técnicas de imagen y con la cirugía.
Palabras clave:
Endometriosis
Resonancia magnética
Imagen por RM
Dolor pelviano
Article
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References
[1]
S.E. Bulun.
Endometriosis.
N Engl J Med, 360 (2009), pp. 268-279
[2]
R.O. Burney, L.C. Giudice.
Pathogenesis and pathophysiology of endometriosis.
Fertil Steril, 98 (2012), pp. 511-519
[3]
P.R. Koninckx, A. Ussia, L. Adamyan, A. Wattiez, J. Donnez.
Deep endometriosis: definition, diagnosis, and treatment.
Fertil Steril, 98 (2012), pp. 564-571
[4]
G. Hudelist, N. Fritzer, A. Thomas, C. Niehues, P. Oppelt, D. Haas, et al.
Diagnostic delay for endometriosis in Austria and Germany: causes and possible consequences.
Hum Reprod, 27 (2012), pp. 3412-3416
[5]
C. Van Holsbeke, B. Van Calster, S. Guerriero, L. Savelli, D. Paladini, A.A. Lissoni, et al.
Endometriomas: their ultrasound characteristics.
Ultrasound Obstet Gynecol, 35 (2010), pp. 730-740
[6]
N. Hottat, C. Larrousse, V. Anaf, J.C. Noël, C. Matos, J. Absil, et al.
Endometriosis: contribution of 3.0-T pelvic MR imaging in preoperative assessment-initial results.
Radiology, 253 (2009), pp. 126-134
[7]
M. Bazot, E. Daraï.
Sonography and MR imaging for the assessment of deep pelvic endometriosis.
J Minim Invasive Gynecol, 12 (2005), pp. 178-185
[8]
A.L. Hsu, I. Khachikyan, P. Stratton.
Invasive and noninvasive methods for the diagnosis of endometriosis.
Clin Obstet Gynecol, 53 (2010), pp. 413-419
[9]
C. Schneider, F. Oehmke, H.R. Tinneberg, G.A. Krombach.
MRI technique for the preoperative evaluation of deep infiltrating endometriosis: current status and protocol recommendation.
Clin Radiol, 71 (2016), pp. 179-194
[10]
E.M. Botterill, S.J. Esler, K.T. McIlwaine, N. Jagasia, L. Ellett, P.J. Maher, et al.
Endometriosis: does the menstrual cycle affect magnetic resonance (MR) imaging evaluation.
Eur J Radiol, 84 (2015), pp. 2071-2079
[11]
M. Chassang, S. Novellas, C. Bloch-Marcotte, J. Delotte, O. Toullalan, A. Bongain, et al.
Utility of vaginal and rectal contrast medium in MRI for the detection of deep pelvic endometriosis.
Eur Radiol, 20 (2010), pp. 1003-1010
[12]
A. Scardapane, F. Lorusso, M. Scioscia, A. Ferrante, A.A. Stabile Ianora, G. Angelelli.
Standard high-resolution pelvic MRI vs. low-resolution pelvic MRI in the evaluation of deep infiltrating endometriosis.
Eur Radiol, 24 (2014), pp. 2590-2596
[13]
M. Bazot, A. Stivalet, E. Darai, C. Coudray, I. Thomassin-Naggara, E. Poncelet.
Comparison of 3D and 2D FSE T2-weighted MRI in the diagnosis of deep pelvic endometriosis: preliminary results.
Clin Radiol, 68 (2013), pp. 47-54
[14]
M. Takeuchi, K. Matsuzaki, M. Harada.
Susceptibility-weighted MRI of extra-ovarian endometriosis: preliminary results.
Abdom Imaging, 40 (2015), pp. 2512-2516
[15]
C. Cimsit, T. Yoldemir, M. Guclu, I.N. Akpinar.
Susceptibility-weighted magnetic resonance imaging for the evaluation of deep infiltrating endometriosis: preliminary results.
Acta Radiol, 57 (2016), pp. 878-885
[16]
C. de Venecia, S.M. Ascher.
Pelvic endometriosis: spectrum of magnetic resonance imaging findings.
Semin Ultrasound CT MR, 36 (2015), pp. 385-393
[17]
M. Bazot, A. Gasner, C. Lafont, M. Ballester, E. Daraï.
Deep pelvic endometriosis: limited additional diagnostic value of postcontrast in comparison with conventional MR images.
Eur J Radiol, 80 (2011), pp. e331-e339
[18]
S. McDermott, T.N. Oei, V.R. Iyer, S.I. Lee.
MR imaging of malignancies arising in endometriomas and extraovarian endometriosis.
Radiographics, 32 (2012), pp. 845-863
[19]
M.G. Thomeer, A.B. Steensma, E.J. van Santbrink, F.E. Willemssen, P.A. Wielopolski, M.G. Hunink, et al.
Can magnetic resonance imaging at 3.0-Tesla reliably detect patients with endometriosis? Initial results.
Obstet Gynaecol Res, 40 (2014), pp. 1051-1058
[20]
M.A. Fraser, S. Agarwal, I. Chen, S.S. Singh.
Routine vs. expert-guided transvaginal ultrasound in the diagnosis of endometriosis: a retrospective review.
Abdom Imaging, 40 (2015), pp. 587-594
[21]
E. Outwater, M.L. Schiebler, R.S. Owen, M.D. Schnall.
Characterization of hemorrhagic adnexal lesions with MR imaging: blinded reader study.
Radiology, 186 (1993), pp. 489-494
[22]
E.S. Siegelman, E.R. Oliver.
MR imaging of endometriosis: ten imaging pearls.
Radiographics, 32 (2012), pp. 1675-1691
[23]
A. Coutinho Jr., L.K. Bittencourt, C.E. Pires, F. Junqueira, C.M. Lima, E. Coutinho, et al.
MR imaging in deep pelvic endometriosis: a pictorial essay.
Radiographics, 31 (2011), pp. 549-567
[24]
J.H. Yoon, D. Choi, K.T. Jang, C.K. Kim, H. Kim, S.J. Lee, et al.
Deep rectosigmoid endometriosis: mushroom cap sign on T2-weighted MR imaging.
Abdom Imaging, 35 (2010), pp. 726-731
[25]
P. Rousset, N. Peyron, M. Charlot, F. Chateau, F. Golfier, D. Raudrant, et al.
Bowel endometriosis: preoperative diagnostic accuracy of 3.0-T MR enterography – initial results.
Radiology, 273 (2014), pp. 117-124
[26]
S. Novellas, M. Chassang, J. Delotte, O. Toullalan, A. Chevallier, J. Bouaziz, et al.
MRI characteristics of the uterine junctional zone: from normal to the diagnosis of adenomyosis.
AJR Am J Roentgenol, 196 (2011), pp. 1206-1213
[27]
M. Takeuchi, K. Matsuzaki.
Adenomyosis: usual and unusual imaging manifestations, pitfalls, and problem-solving MR imaging techniques.
Radiographics, 31 (2011), pp. 99-115
[28]
B. Gui, A.L. Valentini, V. Ninivaggi, M. Marino, M. Iacobucci, L. Bonomo.
Deep pelvic endometriosis: don’t forget round ligaments. Review of anatomy, clinical characteristics, and MR imaging features.
Abdom Imaging, 39 (2014), pp. 622-632
[29]
M.P. Busard, V. Mijatovic, A.B. Lüchinger, M.C. Bleeker, I.C. Pieters-van den Bos, R. Schats, et al.
MR imaging of bladder endometriosis and its relationship with the anterior uterine wall: experience in a tertiary referral centre.
Eur J Radiol, 81 (2012), pp. 2106-2111
[30]
K. Krüger, L. Gilly, G. Niedobitek-Kreuter, L. Mpinou, A.D. Ebert.
Bladder endometriosis: characterization by magnetic resonance imaging and the value of documenting ureteral involvement.
Eur J Obstet Gynecol Reprod Biol, 176 (2014), pp. 39-43
[31]
S. Sillou, S. Poirée, A.E. Millischer, C. Chapron, O. Hélénon.
Urinary endometriosis: MR imaging appearance with surgical and histological correlations.
Diagn Interv Imaging, 96 (2015), pp. 373-381
[32]
R. Vellido-Cotelo, J.L. Muñoz-González, M.R. Oliver-Pérez, C. de la Hera-Lázaro, C. Almansa-González, C. Pérez-Sagaseta, et al.
Endometriosis node in gynaecologic scars: a study of 17 patients and the diagnostic considerations in clinical experience in tertiary care center.
BMC Womens Health, 15 (2015), pp. 13
[33]
A. Randriamarolahy, H. Perrin, J.M. Cucchi, F. Fuerxer, P. Brunner, J.N. Bruneton.
Endometriosis following cesarean section: ultrasonography and magnetic resonance imaging.
Clin Imaging, 34 (2010), pp. 113-115
[34]
J.R. Floyd 2nd, E.R. Keeler, E.D. Euscher, I.E. McCutcheon.
Cyclic sciatica from extrapelvic endometriosis affecting the sciatic nerve.
J Neurosurg Spine, 14 (2011), pp. 281-289
[35]
D. Haas, O. Shebl, A. Shamiyeh, P. Oppelt.
The rASRM score and the Enzian classification for endometriosis: their strengths and weaknesses.
Acta Obstet Gynecol Scand, 92 (2013), pp. 3-7
[36]
V. Di Paola, R. Manfredi, F. Castelli, R. Negrelli, S. Mehrabi, R. Pozzi Mucelli.
Detection and localization of deep endometriosis by means of MRI and correlation with the ENZIAN score.
Eur J Radiol, 84 (2015), pp. 568-574
[37]
N. Morisawa, A. Kido, M. Kataoka, S. Minamiguchi, I. Konishi, K. Togashi.
Magnetic resonance imaging manifestations of decidualized endometriotic cysts: comparative study with ovarian cancers associated with endometriotic cysts.
J Comput Assist Tomogr, 38 (2014), pp. 879-884
[38]
L.R. Medeiros, M.I. Rosa, B.R. Silva, M.E. Reis, C.S. Simon, E.R. Dondossola, et al.
Accuracy of magnetic resonance in deeply infiltrating endometriosis: a systematic review and meta-analysis.
Arch Gynecol Obstet, 291 (2015), pp. 611-621
[39]
R.F. Grasso, V. Di Giacomo, P. Sedati, O. Sizzi, G. Florio, E. Faiella, et al.
Diagnosis of deep infiltrating endometriosis: accuracy of magnetic resonance imaging and transvaginal 3D ultrasonography.
Abdom Imaging, 35 (2010), pp. 716-725
[40]
M. Bazot, C. Lafont, R. Rouzier, G. Roseau, I. Thomassin-Naggara, E. Daraï.
Diagnostic accuracy of physical examination, transvaginal sonography, rectal endoscopic sonography, and magnetic resonance imaging to diagnose deep infiltrating endometriosis.
Fertil Steril, 92 (2009), pp. 1825-1833
[41]
C. Gauche Cazalis, M. Koskas, B. Martin, L. Palazzo, P. Madelenat, C. Yazbeck.
Imagerie préopératoire dans l’endométriose profonde: échographie pelvienne, écho-endoscopie rectale et IRM.
Gynecol Obstet Fertil, 40 (2012), pp. 634-641
[42]
C. Saccardi, E. Cosmi, A. Borghero, A. Tregnaghi, S. Dessole, P. Litta.
Comparison between transvaginal sonography, saline contrast sonovaginography and magnetic resonance imaging in the diagnosis of posterior deep infiltrating endometriosis.
Ultrasound Obstet Gynecol, 40 (2012), pp. 464-469
[43]
M.S. Abrao, M.O. Gonçalves, J.A. Dias Jr., S. Podgaec, L.P. Chamie, R. Blasbalg.
Comparison between clinical examination, transvaginal sonography and magnetic resonance imaging for the diagnosis of deep endometriosis.
Hum Reprod, 22 (2007), pp. 3092-3097
