Diffusion tensor imaging and tractography to evaluate sacral nerve root abnormalities in endometriosis-related pain: A pilot study

• Published in: European radiology Vol. 24; no. 1; pp. 95 - 101
• Main Authors: Manganaro, L., Porpora, M. G., Vinci, V., Bernardo, S., Lodise, P., Sollazzo, P., Sergi, M. E., Saldari, M., Pace, G., Vittori, G., Catalano, C., Pantano, P.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.01.2014; Springer Nature B.V
• Subjects: Adolescent; Adult; Anisotropy; Chronic Pain - diagnosis; Chronic Pain - etiology; Diagnostic Radiology; Diffusion Tensor Imaging - methods; Endometriosis; Endometriosis - complications; Endometriosis - diagnosis; Female; Follow-Up Studies; Gynecology; Hospitals; Humans; Image Processing, Computer-Assisted; Imaging; Internal Medicine; Interventional Radiology; Laparoscopy; Magnetic Resonance; Magnetic resonance imaging; Medicine; Medicine & Public Health; Nervous system; Neuroradiology; Obstetrics; Pain; Pain Measurement; Pelvic Pain - diagnosis; Pelvic Pain - etiology; Pelvis; Pilot Projects; Prospective Studies; Radiology; Reproducibility of Results; ROC Curve; Sacrum; Spinal Nerve Roots - pathology; Ultrasonic imaging; Ultrasound; Womens health; Young Adult; Rome Italy; Italy; DTI; Endometriosis; Pelvic MRI; Tractography; Chronic pelvic pain
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-013-2981-0

Objective To prospectively evaluate microstructural abnormalities in sacral nerve roots in women affected by chronic pelvic pain associated with endometriosis. Methods We enrolled 30 women with an ultrasound diagnosis of endometriosis and moderate-severe chronic pelvic pain; 10 age-matched healthy women comprised the control group. All subjects underwent 3 T magnetic resonance imaging (MRI), including diffusion tensor imaging (DTI); the sacral roots were reconstructed by post-processing the DTI data with dedicated software. Mean fractional anisotropy (FA) values in the S1, S2 and S3 roots were quantified. Analysis of FA values was performed by two radiologists in order to evaluate the interobserver agreement. Results The sacral nerve roots in healthy subjects were clearly visualised. Most of the patients with endometriosis displayed abnormalities of S1, S2 and S3 bilaterally at tractography, including an irregular and disorganised appearance. FA values in the S1, S2 and S3 roots were significantly lower in patients than in controls ( P  < 0.0001, <0.05 and <0.02, respectively) for both observers. No significant difference was found between observers. Conclusion DTI with tractography is a non-invasive means of detecting changes in the microarchitecture of the sacral nerve roots. It can qualitatively and quantitatively reveal sacral root abnormalities in patients with endometriosis-associated pain. Key Points • MRI is increasingly used for endometriosis and chronic pelvic pain (CPP). • Magnetic resonance tractography can demonstrate microarchitectural abnormalities in sacral nerve roots. • Tractography shows altered microstructure of sacral roots affected by endometriosis and CPP. • S1–S3 fractional anisotropy values are lower in endometriosis than in healthy women. • Sacral nerve root alteration may explain the nature of endometriosis-related CPP.