To estimate the benefit of pelvic magnetic resonance (MR) imaging after routine pelvic ultrasound (US) in patients with pathologically or surgically proven endometriosis.
Patients with surgically or pathologically proven endometriosis who had routine pelvic US followed by pelvic MR within 6 months prior to surgery were included. Patients were excluded if they had previously confirmed endometriosis, pregnancy, or surgery > 6 months after MR. The detection rate of endometriosis by pelvic US and MR was compared to the surgical/pathological reference standard.
83 female patients (mean age 40 ± 9) met inclusion criteria and had surgical/pathological confirmation of endometriosis. The mean time interval between pelvic US and MR was 33 ± 43 days, with 64 ± 69 days between MR examination and surgery. US detected endometriosis in 22% (18/83) of patients compared to 61% (51/83) for MR (p < 0.0001). 51% (33/65) of patients with a negative pelvic US exam had a positive MR. MR identified additional sites or sequela in the majority of patients with a positive US (14/18; 78%), including extraovarian locations [e.g., fallopian tubes 7/18 (39%), uterus 7/18 (39%), uterine ligaments 6/18 (33%), posterior cul de sac 5/18 (28%), pelvic side walls 5/18 (28%), abdominal wall 1/18 (6%)] and sequela [ovarian tethering 5/18 (28%), 6/18 (33%) bowel adhesive disease, posterior cul de sac obliteration 2/18 (11%), hydrosalpinx 2/18 (11%), and hydronephrosis 1/18 (6%)]. 3 T MR detected endometriosis in 33/46 (72%) patients compared to 18/37 (49%) for 1.5 T MR (p = 0.03).
Pelvic MR imaging had a higher detection rate of surgically/pathologically proven endometriosis and provides more information about disease location and sequela compared to routine pelvic US.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Nisolle M, Donnez J (1997) Peritoneal endometriosis, ovarian endometriosis, and adenomyotic nodules of the rectovaginal septum are three different entities. Fertil Steril 68 (4):585-596
Giudice LC, Kao LC (2004) Endometriosis. Lancet 364 (9447):1789-1799. https://doi.org/10.1016/s0140-6736(04)17403-5
Riazi H, Tehranian N, Ziaei S, Mohammadi E, Hajizadeh E, Montazeri A (2015) Clinical diagnosis of pelvic endometriosis: a scoping review. BMC Womens Health 15:39. https://doi.org/10.1186/s12905-015-0196-z
Goncalves MO, Podgaec S, Dias JA, Jr., Gonzalez M, Abrao MS (2010) Transvaginal ultrasonography with bowel preparation is able to predict the number of lesions and rectosigmoid layers affected in cases of deep endometriosis, defining surgical strategy. Hum Reprod 25 (3):665-671. https://doi.org/10.1093/humrep/dep433
Hottat N, Larrousse C, Anaf V, Noel JC, Matos C, Absil J, Metens T (2009) Endometriosis: contribution of 3.0-T pelvic MR imaging in preoperative assessment–initial results. Radiology 253 (1):126-134. https://doi.org/10.1148/radiol.2531082113
Piketty M, Chopin N, Dousset B, Millischer-Bellaische AE, Roseau G, Leconte M, Borghese B, Chapron C (2009) Preoperative work-up for patients with deeply infiltrating endometriosis: transvaginal ultrasonography must definitely be the first-line imaging examination. Hum Reprod 24 (3):602-607. https://doi.org/10.1093/humrep/den405
Rousset P, Peyron N, Charlot M, Chateau F, Golfier F, Raudrant D, Cotte E, Isaac S, Rety F, Valette PJ (2014) Bowel endometriosis: preoperative diagnostic accuracy of 3.0-T MR enterography–initial results. Radiology 273 (1):117-124. https://doi.org/10.1148/radiol.14132803
Chamie LP, Blasbalg R, Pereira RM, Warmbrand G, Serafini PC (2011) Findings of pelvic endometriosis at transvaginal US, MR imaging, and laparoscopy. Radiographics 31 (4):E77-100. https://doi.org/10.1148/rg.314105193
Darvishzadeh A, McEachern W, Lee TK, Bhosale P, Shirkhoda A, Menias C, Lall C (2016) Deep pelvic endometriosis: a radiologist’s guide to key imaging features with clinical and histopathologic review. Abdom Radiol (NY) 41 (12):2380-2400. https://doi.org/10.1007/s00261-016-0956-8
Fraser MA, Agarwal S, Chen I, Singh SS (2015) Routine vs. expert-guided transvaginal ultrasound in the diagnosis of endometriosis: a retrospective review. Abdom Imaging 40 (3):587-594. https://doi.org/10.1007/s00261-014-0243-5
Young SW, Dahiya N, Patel MD, Abrao MS, Magrina JF, Temkit M, Kho RM (2017) Initial Accuracy of and Learning Curve for Transvaginal Ultrasound with Bowel Preparation for Deep Endometriosis in a US Tertiary Care Center. J Minim Invasive Gynecol 24 (7):1170-1176. https://doi.org/10.1016/j.jmig.2017.07.002
Bazot M, Bharwani N, Huchon C, Kinkel K, Cunha TM, Guerra A, Manganaro L, Bunesch L, Kido A, Togashi K, Thomassin-Naggara I, Rockall AG (2017) European society of urogenital radiology (ESUR) guidelines: MR imaging of pelvic endometriosis. Eur Radiol 27 (7):2765-2775. https://doi.org/10.1007/s00330-016-4673-z
Abrao MS, Goncalves 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 (12):3092-3097. https://doi.org/10.1093/humrep/dem187
Leone Roberti Maggiore U, Biscaldi E, Vellone VG, Venturini PL, Ferrero S (2017) Magnetic resonance enema vs rectal water-contrast transvaginal sonography in diagnosis of rectosigmoid endometriosis. Ultrasound Obstet Gynecol 49 (4):524-532. https://doi.org/10.1002/uog.15934
Ros C, Martinez-Serrano MJ, Rius M, Abrao MS, Munros J, Martinez-Zamora MA, Gracia M, Carmona F (2017) Bowel Preparation Improves the Accuracy of Transvaginal Ultrasound in the Diagnosis of Rectosigmoid Deep Infiltrating Endometriosis: A Prospective Study. J Minim Invasive Gynecol 24 (7):1145-1151. https://doi.org/10.1016/j.jmig.2017.06.024
Guerriero S, Alcazar JL, Pascual MA, Ajossa S, Perniciano M, Piras A, Mais V, Piras B, Schirru F, Benedetto MG, Saba L (2017) Deep Infiltrating Endometriosis: Comparison Between 2-Dimensional Ultrasonography (US), 3-Dimensional US, and Magnetic Resonance Imaging. J Ultrasound Med. https://doi.org/10.1002/jum.14496
Nisenblat V, Bossuyt PM, Farquhar C, Johnson N, Hull ML (2016) Imaging modalities for the non-invasive diagnosis of endometriosis. Cochrane Database Syst Rev 2:CD009591. https://doi.org/10.1002/14651858.cd009591.pub2
Foti PV, Farina R, Palmucci S, Vizzini IAA, Libertini N, Coronella M, Spadola S, Caltabiano R, Iraci M, Basile A, Milone P, Cianci A, Ettorre GC (2018) Endometriosis: clinical features, MR imaging findings and pathologic correlation. Insights Imaging 9 (2):149-172. https://doi.org/10.1007/s13244-017-0591-0
Woodward PJ, Sohaey R, Mezzetti TP, Jr. (2001) Endometriosis: radiologic-pathologic correlation. Radiographics 21 (1):193-216; questionnaire 288-194. https://doi.org/10.1148/radiographics.21.1.g01ja14193
Manganaro L, Fierro F, Tomei A, Irimia D, Lodise P, Sergi ME, Vinci V, Sollazzo P, Porpora MG, Delfini R, Vittori G, Marini M (2012) Feasibility of 3.0T pelvic MR imaging in the evaluation of endometriosis. Eur J Radiol 81 (6):1381-1387. https://doi.org/10.1016/j.ejrad.2011.03.049
Thomeer MG, Steensma AB, van Santbrink EJ, Willemssen FE, Wielopolski PA, Hunink MG, Spronk S, Laven JS, Krestin GP (2014) Can magnetic resonance imaging at 3.0-Tesla reliably detect patients with endometriosis? Initial results. J Obstet Gynaecol Res 40 (4):1051-1058. https://doi.org/10.1111/jog.12290
Allegre L, Aristizabal P, Nyangoh Timoh K, Thomassin-Naggara I, Kermarrec E, Bendifallah S, Darai E (2018) Comparison of 3-Tesla to 1.5-Tesla Magnetic Resonance Enterography to assess multifocal and multicentric bowel endometriosis: Results in routine practice. Eur J Obstet Gynecol Reprod Biol 230:172-177. https://doi.org/10.1016/j.ejogrb.2018.09.035
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Bartlett, D.J., Burkett, B.J., Burnett, T.L. et al. Comparison of routine pelvic US and MR imaging in patients with pathologically confirmed endometriosis. Abdom Radiol 45, 1670–1679 (2020). https://doi.org/10.1007/s00261-019-02124-x
- Magnetic resonance imaging (MRI)
- Women’s health