Journal des soins de santé des femmes
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Diagnosis of Deeply Infiltrative Endometriosis: Accuracy of a Specific Magnetic Resonance Imaging Protocol

Ito ET, Anane JO, Moawad G, Vargas MV, Marfori C, Taffel M and Robinson J

Objective: To evaluate the accuracy of a specific magnetic resonance imaging (MRI) protocol in diagnosing the extent and location of deeply infiltrative endometriosis (DIE).
Methods: A retrospective chart review of women age 20 to 51 years of age who had a preoperative evaluation suspicious for DIE base on: 1) preoperative examination showing a rectovaginal mass or nodularity, non-mobile uterus fixed to rectum, and/or an adnexal mass, 2) severe or cyclic dysuria, dyschezia, and/or dyspareunia, or 3) a history of prior surgery for advanced staged endometriosis. These women subsequently underwent an institution specific endometriosis protocol pelvic MRI. Our MRI endometriosis protocol uses a 1.5T machine which takes images in T2, T1 non- fat saturation, and a fat saturation T1 in axial orientation along all three planes pre and postcontrast. Slices are thinner in the T1 and T2 images using the endometriosis protocol compared to the standard protocol. Intra-operative data were collected for women who underwent surgery for endometriosis. MRI findings were compared with intraoperative findings. Twenty-six women who had high suspicion for DIE on our institution specific MRI and subsequently underwent a laparoscopic surgery by a single minimally invasive gynaecologic surgeon were included in our study.
Results: Of the twenty-six women, who met criteria for our study, twenty-one were found to have DIE, two were found to have superficial endometriosis, and there was one case of a tubo-ovarian abscess. Two were found to have other pelvic pathology such as fibroids, cysts, adhesions, and/or fibrosis. For patients with a high preoperative suspicion of DIE, our MRI protocol had a sensitivity of 82%, specificity of 80%, PPV of 95%, NPV of 50%. Conclusions: Our standardized endometriosis MRI protocol predicts the extent of DIE. Benefits of MRI include potential to replace multiple imaging exams, improve preoperative planning, and aid in decision for referral to a specialized surgeon.