Systematic Approach to Using Magnetic Resonance Imaging for the Patient with Deep Infiltrating Endometriosis

Abstract

<h3>Study Objective</h3> To demonstrate systematically how to identify deep infiltrative endometriosis (DIE) on MRI and compare preoperative MRI imaging to intraoperative laparoscopic findings. <h3>Design</h3> Video demonstration of MRI images and surgical footage with narrated description. <h3>Setting</h3> Tertiary care academic teaching hospital. <h3>Patients or Participants</h3> Patients with deep infiltrative endometriosis in the anterior, middle, and posterior compartments. <h3>Interventions</h3> Preoperative MRI was completed for patients with suspected DIE due to reported symptoms or examination findings to confirm DIE presence and extension. <h3>Measurements and Main Results</h3> The diagnosis and evaluation of DIE is difficult with physical examination and laparoscopic exploration alone. MRI is easily reproducible and surveys the anterior, middle, and posterior compartments of the pelvis in single study even if lesions are obscured by adhesions. This video reviews how to systematically identify DIE on preoperative MRI and provides specific tips for each pelvic compartment. This video shows how appropriate preoperative planning allows for one step laparoscopy with subspecialty surgeons (e.g.: case 1 with General Surgery, case 3 with Colorectal Surgery). <h3>Conclusion</h3> Because successful treatment of DIE requires surgical excision, preoperative confirmation of DIE presence and extension is extremely important. Surgeons should understand how to evaluate MRI images for DIE and use these findings to guide preoperative surgical planning and intraoperative exploration.