Comparison of routine pelvic US and MR imaging in patients with pathologically confirmed endometriosis

Abstract

Purpose

To estimate the benefit of pelvic magnetic resonance (MR) imaging after routine pelvic ultrasound (US) in patients with pathologically or surgically proven endometriosis.

Methods

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.

Results

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).

Conclusion

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.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

References

  1. 1.

    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

    CAS  Article  Google Scholar 

  2. 2.

    Giudice LC, Kao LC (2004) Endometriosis. Lancet 364 (9447):1789-1799. https://doi.org/10.1016/s0140-6736(04)17403-5

    Article  PubMed  Google Scholar 

  3. 3.

    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

    Article  PubMed  PubMed Central  Google Scholar 

  4. 4.

    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

    Article  PubMed  Google Scholar 

  5. 5.

    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

  6. 6.

    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

    Article  PubMed  Google Scholar 

  7. 7.

    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

  8. 8.

    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

    Article  PubMed  Google Scholar 

  9. 9.

    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

    Article  Google Scholar 

  10. 10.

    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

  11. 11.

    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

    Article  PubMed  Google Scholar 

  12. 12.

    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

    CAS  Article  PubMed  Google Scholar 

  13. 13.

    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

    Article  PubMed  Google Scholar 

  14. 14.

    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

    CAS  Article  PubMed  Google Scholar 

  15. 15.

    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

    Article  PubMed  Google Scholar 

  16. 16.

    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

  17. 17.

    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

  18. 18.

    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

    Article  PubMed  PubMed Central  Google Scholar 

  19. 19.

    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

  20. 20.

    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

  21. 21.

    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

  22. 22.

    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

    Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Wendaline M. VanBuren.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

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

Download citation

Keywords

  • Endometriosis
  • Magnetic resonance imaging (MRI)
  • Ultrasound
  • Women’s health
  • Radiology
  • Gynecology