MRI of Endometriosis: Single institute experience including MRI classification and Laparoscopic correlation with ENZIAN classification

Abstract

BackgroundEndometriosis is a chronic gynecological condition affecting women of reproductive age and may cause pelvic pain and infertility. MRI is the best imaging technique for mapping and preoperative staging of endometriosis as it provides a tool for the assessment of deep infiltrating endometriosis. The aim of this study was to evaluate the role of magnetic resonance imaging (MRI) in detection and characterization of endometriosis in correlation between it and the laparoscopic findings according to ENZIAN classification.MethodsWe assessed 100 patients by MRI dedicated pelvis protocol for endometriosis with an assessment of the ovaries, uterus, uterosacral ligaments (USL), broad ligaments, and round ligaments, cul-de-sac, rectosigmoid colon, bladder, ureters, and rectovaginal septum. All these patients are submitted for laparoscopy, and then, data from both investigations were correlated.ResultsMRI provided a road map for surgeons before laparoscopy. The sensitivity of MRI was 87.5% in small deep infiltrating endometriosis (DIE) (grade A1) and 100% in large DIE (A2). MRI detected 82.3% of uterosacral ligament involvement, specificity 80%. Detection rate in rectal involvement was 71.4%, specificity 75%. There was 100% sensitivity and specificity in adenomyosis and urinary bladder endometriosis.ConclusionsPreoperative detection of endometriotic lesions is recommended using a dedicated MRI endometriosis protocol to choose the surgical approach and for proper multidisciplinary teamwork planning.