MRI-Ultrasound Fusion Imaging for Diagnosis of Deep Infiltrating Endometriosis – A Critical Appraisal

Abstract

PurposeIt was the aim of our study to evaluate this procedure using pelvic anatomical landmarks in order to assess the accuracy of fusion imaging and to critically evaluate the applicability in daily practice.MethodsIn a prospective, single center study, 10 patients with clinical signs of deep infiltrating endometriosis (DIE) were selected. We measured the distance between the landmark organ and the target shown by the software system (measurement 1). Measurement 2 depicts the distance between the landmark and the nearest calibration point. The calibration inaccuracy was measured as a third type of measurement (measurement 3).ResultsMeasurement 1: the average distance between the organ landmark to the target was 13.6 mm (range: 0–96 mm). Measurement 2: in 31 of the 40 attempts (77.5 %), we could measure the distance from the landmark organ to the nearest calibration point. The average distance was 34.4 mm (range: 0–69 mm).Measurement 3: A perfect match was seen in 6 of 20 attempts (30.0 %). There was a deviation in 14 of the 20 attempts (70.0 %). The mean distance was 11.1 mm (range: 6–23 mm). Conclusion Although very promising, MRI-ultrasound fusion imaging (MUFI) currently cannot be readily implemented into daily practice as a routine evaluation of DIE.

Fusion of ultrasound and 3D single‐photon‐emission computed tomography/computed tomography to identify sentinel lymph nodes in vulvar cancer: feasibility study

“…They demonstrated in a prospective study involving 17 patients that, by combining the information from both ultrasound and MRI, the performance of these imaging modalities alone in the identification of the main anatomical sites of deep infiltrating endometriosis could be improved. Three studies have since been conducted on ultrasound fusion imaging in gynecology, only one of which explored its use in gynecological oncology. Théodore et al .…”

“…They demonstrated in a prospective study involving 17 patients that, by combining the information from both ultrasound and MRI, the performance of these imaging modalities alone in the identification of the main anatomical sites of deep infiltrating endometriosis could be improved. Three studies have since been conducted on ultrasound fusion imaging in gynecology 39,41,42 , only one of which explored its use in gynecological oncology 39 . Théodore et al 39 showed, in 13 patients with cervical cancer, that MRI and ultrasound fusion imaging could improve cervical cancer lesion characterization and parametrial infiltration detection in comparison with MRI alone.…”

“…However, the applications of fusion imaging in gynecological diseases are still poorly explored and, to the best of our knowledge, no study has explored the role of fusion imaging in detecting sentinel lymph nodes in women with vulvar cancer. Thus, the present study aimed to evaluate the feasibility of fusion of three‐dimensional (3D) SPECT/CT and ultrasound imaging in detecting sentinel lymph nodes in women with vulvar cancer.…”

The use of image fusion in prenatal medicine

“…Many publications have analysed and confirmed the diagnostic performance of transvaginal ultrasound (TVS) and MRI, the two most frequently used non‐invasive modalities for gynaecological investigations, especially for adenomyosis and endometriosis. In 2015, Millischer et al and more recently, Berger et al confirmed the added value of FI to improve the diagnosis of deep endometriosis . Vinci et al also experimented FI in diagnosis and description of adenomyosis .…”

Fusion imaging of ultrasound and MRI in the assessment of locally advanced cervical cancer: a prospective study

“…Thus fusion imaging represents a new diagnostic method that integrates both ultrasound and MRI examinations, and was recently shown to increase the diagnostic accuracy of the single imaging method 12. In particular, this diagnostic tool has been tested in the diagnosis of deep infiltrating endometriosis13 14 and in prenatal diagnosis 15. Fusion is also recognized as a guide for both diagnosis and treatment of several cancers.…”