Purpose: To evaluate the accuracy of magnetic resonance (MRI) in the assessment of extrapelvic endometriosis. Methods and Materials: The MRI exams of 127 patients (mean age 29.8 years) suffering from severe pelvic endometriosis, performed within 1 week before laparoscopy, were retrospectively reviewed by two readers. Number, site, size of each implant were evaluated. At MRI, diagnosis was based on hyperintense lesions on T1-WI, plaque-like hypointense lesions on T1 and T2-WI, or indirect findings (tethering, thickening of peritoneal fat and visceral wall). Using laparoscopy as reference standard, MRI diagnostic accuracy was calculated. Pearson test was used to compare lesions size. Interobserver variability in determining the presence of extrapelvic disease was assessed with k statistics. A value of p < 0.05 was considered significant. Results: At laparoscopy 97 lesions (bowel = 68; peritoneum other than Douglas pouch = 15; bladder = 7; ureters = 7) were identified in 75 patients, with 19 women presenting multiple implants. MR identified 77/97 lesions, missing 14 bowel lesions, 3 of the peritoneum, 2 of the ureters, 1 of the bladder, with 10 false positive findings. MRI diagnosis was based on hyperintense lesions on T1-WI (36), plaque-like lesions (31), indirect findings (10). Sensitivity, specificity, PPV, NPV of MRI were 81 %, 92 %, 94 % and 77 %, respectively. The correlation regarding lesion size at MRI (mean 33 mm) and laparoscopy (mean 34 mm) was good (p < 0.01). Interobserver variability was excellent (k = 0.92). Conclusions: Identifying extrapelvic endometriosis preoperatively, MRI could be useful for treatment planning in case of severe pelvic disease.
Occurrence of extrapelvic localisation of endometriosis in course of severe pelvic disease: role of MRI
FACCIOLI, Niccolò;BARILLARI, Marco;MANFREDI, Riccardo;POZZI MUCELLI, Roberto
2011-01-01
Abstract
Purpose: To evaluate the accuracy of magnetic resonance (MRI) in the assessment of extrapelvic endometriosis. Methods and Materials: The MRI exams of 127 patients (mean age 29.8 years) suffering from severe pelvic endometriosis, performed within 1 week before laparoscopy, were retrospectively reviewed by two readers. Number, site, size of each implant were evaluated. At MRI, diagnosis was based on hyperintense lesions on T1-WI, plaque-like hypointense lesions on T1 and T2-WI, or indirect findings (tethering, thickening of peritoneal fat and visceral wall). Using laparoscopy as reference standard, MRI diagnostic accuracy was calculated. Pearson test was used to compare lesions size. Interobserver variability in determining the presence of extrapelvic disease was assessed with k statistics. A value of p < 0.05 was considered significant. Results: At laparoscopy 97 lesions (bowel = 68; peritoneum other than Douglas pouch = 15; bladder = 7; ureters = 7) were identified in 75 patients, with 19 women presenting multiple implants. MR identified 77/97 lesions, missing 14 bowel lesions, 3 of the peritoneum, 2 of the ureters, 1 of the bladder, with 10 false positive findings. MRI diagnosis was based on hyperintense lesions on T1-WI (36), plaque-like lesions (31), indirect findings (10). Sensitivity, specificity, PPV, NPV of MRI were 81 %, 92 %, 94 % and 77 %, respectively. The correlation regarding lesion size at MRI (mean 33 mm) and laparoscopy (mean 34 mm) was good (p < 0.01). Interobserver variability was excellent (k = 0.92). Conclusions: Identifying extrapelvic endometriosis preoperatively, MRI could be useful for treatment planning in case of severe pelvic disease.
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