Endometriosis: Contribution of 3.0-T Pelvic MR Imaging in Preoperative AssessmentâInitial Results1
Purpose: To determine the accuracy of 3.0-T pelvic magnetic resonance (MR) imaging in the preoperative assessment of endometriosis and to evaluate colon wall involvement after intrarectal gel administration. Materials and Methods: Institutional review board approval for this study was obtained, and...
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Published in | Radiology Vol. 253; no. 1; p. 126 |
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Main Authors | , , , , , , |
Format | Journal Article |
Language | English |
Published |
Radiological Society of North America
01.10.2009
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Online Access | Get full text |
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Summary: | Purpose: To determine the accuracy of 3.0-T pelvic magnetic resonance (MR) imaging in the preoperative assessment of endometriosis
and to evaluate colon wall involvement after intrarectal gel administration.
Materials and Methods: Institutional review board approval for this study was obtained, and each patient gave written informed consent. Forty-one
consecutive patients with clinical suspicion of endometriosis underwent pelvic MR imaging at 3.0 T before surgery. Single-shot
and high-spatial-resolution axial T2-weighted, sagittal fat-suppressed T2-weighted, and axial fat-suppressed T1-weighted sequences
were performed. T2-weighted sequences were repeated after the rectum was filled with ultrasonographic (US) gel. Two blinded
readers interpreted images independently. Image quality was scored by using a four-point scale. Detailed mapping of deep endometriosis
was performed. Colon wall infiltration was graded (none, serosa, muscularis, submucosa, mucosa). MR imaging results were compared
with surgical and pathologic findings. Interobserver agreement was assessed by using κ statistics. Nonparametric tests were
performed to compare colon wall infiltration scores without and those with US gel and between observers.
Results: Twenty-seven of 41 patients had deep endometriosis at surgery and histopathologic examination. Sensitivity, specificity,
positive and negative predictive values, and accuracy for the diagnosis of deep endometriosis at MR imaging were 96.3% (26
of 27), 100% (14 of 14), 100% (26 of 26), 93.3% (14 of 15), and 97.6% (40 of 41), respectively. κ Values ranged from 0.65
to 1.0, depending on the location of deep endometriosis. Colon wall infiltration assessment by both readers correlated well
with pathologic findings (Spearman coefficient, >0.93), although median wall involvement scores were lower at pathologic examination
than for both readers both before ( P = .042 and P = .011) and after ( P = .079 and P = .011) intrarectal gel filling.
Conclusion: MR imaging of the pelvis at 3.0 T is accurate in the diagnosis and staging of deep endometriosis for the preoperative assessment
of patients clinically suspected of having endometriosis.
© RSNA, 2009 |
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ISSN: | 0033-8419 1527-1315 |
DOI: | 10.1148/radiol.2531082113 |