Abstract
Thin-section oblique axial magnetic resonance imaging (MRI) is useful in staging endometrial and cervical carcinomas but there are no data on its contribution to assessing deep endometriosis. We evaluated the contribution of this MRI technique to diagnosis of uterosacral ligament (USL) endometriosis. In this retrospective study, two radiologists, who were blinded to the surgical and histological results, compared the results from conventional sagittal and axial MRI with those from conventional plus thin-section (3 mm) oblique axial MRI in 100 symptomatic patients. Descriptive statistical analyses including sensitivity, specificity, positive and negative predictive values, accuracy and positive and negative likelihood ratios were performed. Kappa for inter-observer agreement was calculated. Conventional MR images for the diagnosis of left/right USL endometriosis revealed accuracies of 69/76 and 59/75%, sensitivities of 66/71 and 52/71% and specificities of 76/86 and 76/82% for senior and junior readers, respectively. The combination of conventional and thin-section oblique axial MR images revealed accuracies of 82/87 and 74/81%, sensitivities of 89/93 and 73/81% and specificities of 61/72 and 76/79%, for senior and junior readers, respectively. When conventional MRI combined with oblique axial T2-weighted MRI was compared with conventional MRI use only, significant differences in diagnostic accuracies were observed for right (P = 0.04) and left (P = 0.01) USL endometriosis. Thin-section oblique axial T2-weighted imaging can improve the success of conventional MRI for assessment of USL endometriosis. Further prospective studies are required before this new MR protocol is performed routinely for suspected pelvic endometriosis.
Highlights
Deep endometriosis is defined by the presence of endometrial implants, fibrosis and muscular hyperplasia below the peritoneum (Cornillie et al, 1990; Anaf et al, 2000; Clement, 2002)
The present study demonstrates the additional value of thin-section oblique axial T2-weighted Magnetic resonance imaging (MRI) when combined with conventional T2-weighted MRI for increasing the detection of Uterosacral ligaments (USLs) endometriosis
Ovarian and peritoneal endometrioses are commonly asymptomatic while chronic pelvic pain, dysmenorrhea, dyspareunia, dyschezia and dysuria reflect the presence of deep endometriosis (Fauconnier et al, 2002)
Summary
Deep endometriosis is defined by the presence of endometrial implants, fibrosis and muscular hyperplasia below the peritoneum (Cornillie et al, 1990; Anaf et al, 2000; Clement, 2002). Uterosacral ligaments (USLs) represent the most frequent location of deep endometriosis (Jenkins et al, 1986; Clement, 2002). Magnetic resonance imaging (MRI) is the reference standard for the non-invasive evaluation of deep endometriosis, offering an exhaustive mapping of the pelvic cavity contributing to the therapeutic strategy for pelvic endometriosis (Bazot et al, 2004a, 2009). Sagittal and axial T2 and T1-weighted MR images represent the usual MRI protocol for the diagnosis of pelvic endometriosis, including USL evaluation (Bazot et al, 2004a). The rationale of our study was to suggest that 5-mm thickness sagittal and axial T2-weighted MR images are not sufficient for the diagnosis of USL endometriosis. Thin-section oblique axial images (i.e. 3 mm thick and oblique to the long axis of the cervix) have been
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