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Moghadam, R. N., Tamizi, F., Ratki, S. K. R., Moghadam, A. N., Javaheri, A., & Namiranian, N. (2024). Evaluation of diagnostic value of pelvic MRI in endometriosis in comparison with surgical findings: A cross-sectional study. International Journal of Reproductive BioMedicine (IJRM), 22(1), 55–60. https://doi.org/10.18502/ijrm.v22i1.15242
https://doi.org/10.18502/ijrm.v22i1.15242
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authors
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Reza Nafisi Moghadam
Reza Nafisi Moghadam
Department of Radiology, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
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Fatemeh Tamizi
Fatemeh Tamizi
Department of Radiology, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
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Seid Kazem Razavi Ratki
Seid Kazem Razavi Ratki
Department of Radiology, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
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Amin Nafisi Moghadam
Amin Nafisi Moghadam
Faculty of Medicine, Aliebnabitaleb Azad University, Yazd, Iran.
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Atiyeh Javaheri
Atiyeh Javaheri
Department of Obstetrics and Gynecology, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
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Nasim Namiranian
Nasim Namiranian
Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
Published Date
- Feb 18, 2024
Evaluation of diagnostic value of pelvic MRI in endometriosis in comparison with surgical findings: A cross-sectional study
Abstract
Background: Endometriosis is a multifocal gynecologic disorder during the fertility period in women. Magnetic resonance imaging (MRI) is an important diagnostic modality for this disease and can either be used alone or along with transvaginal ultrasonography.
Objective: This study aims to compare the accuracy of pelvis MRI in pelvic deep endometriosis with laparoscopic findings in women referred to Shahid Sadoughi hospital in one yr.
Materials and Methods: This cross-sectional study was conducted on 40 women suspicious of endometriosis who referred to Shahid Sadoughi hospital, Yazd, Iran from November 2020-2021. Based on clinical findings and history, participants were referred to the imaging center for pelvic MRI. Finally, the results of MRI and diagnostic laparoscopy were compared with pathologic findings.
Results: The sensitivity and specificity of MRI for pelvic endometriosis were 94.8% and 20%, respectively. Also, the positive predictive value and negative predictive value of MRI were 90.2% and 33.3%, respectively.
Conclusion: Laparoscopy is still the gold standard of endometriosis diagnosis, but MRI with susceptibility-weighted imaging sequence is the best noninvasive diagnostic method.
Key words: Deep infiltrating endometriosis, Magnetic resonance imaging, Diagnosis, Laparoscopy, Sensitivity, Specificity.
References
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[2] Taniguchi F, Sakamoto Y, Yabuta Y, Azuma Y, Hirakawa E, Nagira K, et al. Analysis of pregnancy outcome and decline of anti-Müllerian hormone after laparoscopic cystectomy for ovarian endometriomas. J Obstet Gynaecol Res 2016; 42: 1534–1540.
[3] Khodaverdi S, Alebouyeh MR, Sadegi K, Mehdizadehkashi A, Kaveh M, Entezari SR, et al. Superior hypogastric plexus block as an effective treatment method for endometriosis-related chronic pelvic pain: An open-label pilot clinical trial. J Obstet Gynaecol 2021; 41: 966–971.
[4] Burla L, Scheiner D, Hötker AM, Meier A, Fink D, Boss A, et al. Structured manual for MRI assessment of deep infiltrating endometriosis using the ENZIAN classification. Arch Gynecol Obstet 2021; 303: 751–757.
[5] Culley L, Law C, Hudson N, Denny E, Mitchell H, Baumgarten M, et al. The social and psychological impact of endometriosis on women’s lives: A critical narrative review. Hum Reprod Update 2013; 19: 625–639.
[6] Nnoaham KE, Hummelshoj L, Webster P, d’Hooghe T, de Cicco Nardone F, de Cicco Nardone C, et al. Impact of endometriosis on quality of life and work productivity: A multicenter study across ten countries. Fertil Steril 2011; 96: 366–373.
[7] Di Paola V, Manfredi R, Castelli F, Negrelli R, Mehrabi S, Pozzi Mucelli R. Detection and localization of deep endometriosis by means of MRI and correlation with the ENZIAN score. Eur J Radiol 2015; 84: 568–574.
[8] Nisenblat V, Bossuyt PMM, Farquhar C, Johnson N, Hull ML. Imaging modalities for the non-invasive diagnosis of endometriosis. Cochrane Database Syst Rev 2016; 2: Cd009591.
[9] Dunselman GAJ, Vermeulen N, Becker C, Calhaz-Jorge C, D’Hooghe T, De Bie B, et al. ESHRE guideline: Management of women with endometriosis. Hum Reprod 2014; 29: 400–412.
[10] Burla L, Scheiner D, Pierre Samartzis E, Seidel S, Eberhard M, Fink D, et al. The ENZIAN score as a preoperative MRI-based classification instrument for deep infiltrating endometriosis. Arch Gynecol Obstet 2019; 300: 109–116.
[11] Coutinho Jr A, Bittencourt LK, Pires CE, Junqueira F, de Oliveira Lima CMA, Coutinho E, et al. MR imaging in deep pelvic endometriosis: A pictorial essay. Radiographics 2011; 31: 549–567.
[12] Bazot M, Lafont C, Rouzier R, Roseau G, Thomassin-Naggara I, Daraï E. Diagnostic accuracy of physical examination, transvaginal sonography, rectal endoscopic sonography, and magnetic resonance imaging to diagnose deep infiltrating endometriosis. Fertil Steril 2009; 92: 1825–1833.
[13] Siegelman ES, Oliver ER. MR imaging of endometriosis: Ten imaging pearls. Radiographics 2012; 32: 1675–1691.
[14] Kruger K, Behrendt K, Niedobitek-Kreuter G, Koltermann K, Ebert AD. Location-dependent value of pelvic MRI in the preoperative diagnosis of endometriosis. Eur J Obstet Gynecol Reprod Biol 2013; 169: 93–98.
[15] Bianek-Bodzak A, Szurowska E, Sawicki S, Liro M. The importance and perspective of magnetic resonance imaging in the evaluation of endometriosis. Biomed Res Int 2013; 2013: 436589.
[16] Thomeer MG, Steensma AB, van Santbrink EJ, Willemssen FE, Wielopolski PA, Hunink MG, et al. Can magnetic resonance imaging at 3.0-Tesla reliably detect patients with endometriosis? Initial results. J Obstet Gynaecol Res 2014; 40: 1051–1058.
[17] Scardapane A, Lorusso F, Bettocchi S, Moschetta M, Fiume M, Vimercati A, et al. Deep pelvic endometriosis: Accuracy of pelvic MRI completed by MR colonography. Radiol Med 2013; 118: 323–338.
[18] Koninckx PR, Ussia A, Adamyan L, Wattiez A, Donnez J. Deep endometriosis: Definition, diagnosis, and treatment. Fertil Steril 2012; 98: 564–571.
[19] Berger JP, Rhemrev J, Smeets M, Henneman O, English J, Jansen FW. Limited added value of magnetic resonance imaging after dynamic transvaginal ultrasound for preoperative staging of endometriosis in daily practice: A prospective cohort study. J Ultrasound Med 2019; 38: 989–996.
[20] Bielen D, Tomassetti C, Van Schoubroeck D, Vanbeckevoort D, De Wever L, Van den Bosch T, et al. IDEAL study: Magnetic resonance imaging for suspected deep endometriosis assessment prior to laparoscopy is as reliable as radiological imaging as a complement to transvaginal ultrasonography. Ultrasound Obstet Gynecol 2020; 56: 255–266.
[21] Stratton P, Winkel C, Premkumar A, Chow C, Wilson J, Hearns-Stokes R, et al. Diagnostic accuracy of laparoscopy, magnetic resonance imaging, and histopathologic examination for the detection of endometriosis. Fertil Steril 2003; 79: 1078–1085.
[22] Saba L, Guerriero S, Sulis R, Pilloni M, Ajossa S, Melis G, et al. Learning curve in the detection of ovarian and deep endometriosis by using magnetic resonance: Comparison with surgical results. Eur J Radiol 2011; 79: 237–244.
[23] Pin L, Monseau-Thiburce A-C, Ziade-Coularis C, Benjamin A, Menut F, Brun J-L, et al. Exploratory study of the interest of MR susceptibility-weighted imaging for the pre-operative assessment of pelvic endometriosis extent. Eur J Radiol 2019; 118: 245–250.
[2] Taniguchi F, Sakamoto Y, Yabuta Y, Azuma Y, Hirakawa E, Nagira K, et al. Analysis of pregnancy outcome and decline of anti-Müllerian hormone after laparoscopic cystectomy for ovarian endometriomas. J Obstet Gynaecol Res 2016; 42: 1534–1540.
[3] Khodaverdi S, Alebouyeh MR, Sadegi K, Mehdizadehkashi A, Kaveh M, Entezari SR, et al. Superior hypogastric plexus block as an effective treatment method for endometriosis-related chronic pelvic pain: An open-label pilot clinical trial. J Obstet Gynaecol 2021; 41: 966–971.
[4] Burla L, Scheiner D, Hötker AM, Meier A, Fink D, Boss A, et al. Structured manual for MRI assessment of deep infiltrating endometriosis using the ENZIAN classification. Arch Gynecol Obstet 2021; 303: 751–757.
[5] Culley L, Law C, Hudson N, Denny E, Mitchell H, Baumgarten M, et al. The social and psychological impact of endometriosis on women’s lives: A critical narrative review. Hum Reprod Update 2013; 19: 625–639.
[6] Nnoaham KE, Hummelshoj L, Webster P, d’Hooghe T, de Cicco Nardone F, de Cicco Nardone C, et al. Impact of endometriosis on quality of life and work productivity: A multicenter study across ten countries. Fertil Steril 2011; 96: 366–373.
[7] Di Paola V, Manfredi R, Castelli F, Negrelli R, Mehrabi S, Pozzi Mucelli R. Detection and localization of deep endometriosis by means of MRI and correlation with the ENZIAN score. Eur J Radiol 2015; 84: 568–574.
[8] Nisenblat V, Bossuyt PMM, Farquhar C, Johnson N, Hull ML. Imaging modalities for the non-invasive diagnosis of endometriosis. Cochrane Database Syst Rev 2016; 2: Cd009591.
[9] Dunselman GAJ, Vermeulen N, Becker C, Calhaz-Jorge C, D’Hooghe T, De Bie B, et al. ESHRE guideline: Management of women with endometriosis. Hum Reprod 2014; 29: 400–412.
[10] Burla L, Scheiner D, Pierre Samartzis E, Seidel S, Eberhard M, Fink D, et al. The ENZIAN score as a preoperative MRI-based classification instrument for deep infiltrating endometriosis. Arch Gynecol Obstet 2019; 300: 109–116.
[11] Coutinho Jr A, Bittencourt LK, Pires CE, Junqueira F, de Oliveira Lima CMA, Coutinho E, et al. MR imaging in deep pelvic endometriosis: A pictorial essay. Radiographics 2011; 31: 549–567.
[12] Bazot M, Lafont C, Rouzier R, Roseau G, Thomassin-Naggara I, Daraï E. Diagnostic accuracy of physical examination, transvaginal sonography, rectal endoscopic sonography, and magnetic resonance imaging to diagnose deep infiltrating endometriosis. Fertil Steril 2009; 92: 1825–1833.
[13] Siegelman ES, Oliver ER. MR imaging of endometriosis: Ten imaging pearls. Radiographics 2012; 32: 1675–1691.
[14] Kruger K, Behrendt K, Niedobitek-Kreuter G, Koltermann K, Ebert AD. Location-dependent value of pelvic MRI in the preoperative diagnosis of endometriosis. Eur J Obstet Gynecol Reprod Biol 2013; 169: 93–98.
[15] Bianek-Bodzak A, Szurowska E, Sawicki S, Liro M. The importance and perspective of magnetic resonance imaging in the evaluation of endometriosis. Biomed Res Int 2013; 2013: 436589.
[16] Thomeer MG, Steensma AB, van Santbrink EJ, Willemssen FE, Wielopolski PA, Hunink MG, et al. Can magnetic resonance imaging at 3.0-Tesla reliably detect patients with endometriosis? Initial results. J Obstet Gynaecol Res 2014; 40: 1051–1058.
[17] Scardapane A, Lorusso F, Bettocchi S, Moschetta M, Fiume M, Vimercati A, et al. Deep pelvic endometriosis: Accuracy of pelvic MRI completed by MR colonography. Radiol Med 2013; 118: 323–338.
[18] Koninckx PR, Ussia A, Adamyan L, Wattiez A, Donnez J. Deep endometriosis: Definition, diagnosis, and treatment. Fertil Steril 2012; 98: 564–571.
[19] Berger JP, Rhemrev J, Smeets M, Henneman O, English J, Jansen FW. Limited added value of magnetic resonance imaging after dynamic transvaginal ultrasound for preoperative staging of endometriosis in daily practice: A prospective cohort study. J Ultrasound Med 2019; 38: 989–996.
[20] Bielen D, Tomassetti C, Van Schoubroeck D, Vanbeckevoort D, De Wever L, Van den Bosch T, et al. IDEAL study: Magnetic resonance imaging for suspected deep endometriosis assessment prior to laparoscopy is as reliable as radiological imaging as a complement to transvaginal ultrasonography. Ultrasound Obstet Gynecol 2020; 56: 255–266.
[21] Stratton P, Winkel C, Premkumar A, Chow C, Wilson J, Hearns-Stokes R, et al. Diagnostic accuracy of laparoscopy, magnetic resonance imaging, and histopathologic examination for the detection of endometriosis. Fertil Steril 2003; 79: 1078–1085.
[22] Saba L, Guerriero S, Sulis R, Pilloni M, Ajossa S, Melis G, et al. Learning curve in the detection of ovarian and deep endometriosis by using magnetic resonance: Comparison with surgical results. Eur J Radiol 2011; 79: 237–244.
[23] Pin L, Monseau-Thiburce A-C, Ziade-Coularis C, Benjamin A, Menut F, Brun J-L, et al. Exploratory study of the interest of MR susceptibility-weighted imaging for the pre-operative assessment of pelvic endometriosis extent. Eur J Radiol 2019; 118: 245–250.