A Prospective Study Comparing Three-Dimensional Rectal Water Contrast Transvaginal Ultrasonography and Computed Tomographic Colonography in the Diagnosis of Rectosigmoid Endometriosis

Abstract

(1) Objectives: In patients with symptoms suggestive of rectosigmoid endometriosis, imaging techniques are required to confirm the presence and establish the extent of the disease. The objective of the current study was to compare the performance of three-dimensional rectal water contrast transvaginal ultrasonography (3D-RWC-TVS) and computed tomographic colonography (CTC) in predicting the presence and characteristics of rectosigmoid endometriosis. (2) Methods: This prospective study included patients with suspicion of rectosigmoid endometriosis who underwent both 3D-RWC-TVS and CTC and subsequently were surgically treated. The findings of imaging techniques were compared with surgical and histological results. (3) Results: Out of 68 women included in the study, 37 (48.9; 95% C.I. 38.2–59.7%) had rectosigmoid nodules and underwent bowel surgery. There was no significant difference in the accuracy of 3D-RWC-TVS and CTC in diagnosing the presence of rectosigmoid endometriotic nodules (p = 0.118), although CTC was more precise in diagnosing endometriosis located in the sigmoid (p = 0.016). 3D-RWC-TVS and CTC had similar precision in estimating the largest diameter of the main endometriotic nodule (p = 0.099) and, in patients undergoing segmental resection, the degree of the stenosis of the bowel lumen (p = 0.293). CTC was more accurate in estimating the distance between the lower margin of the intestinal nodule and the anal verge (p = 0.030) but was less tolerated than 3D-RWC-TVS (p < 0.001). (4) Conclusion: This was the first study comparing the performance of 3D-RWC-TVS and CTC in the diagnosis of rectosigmoid endometriosis. Both techniques allowed for the evaluation of the profile of the bowel lumen in a pseudoendoscopic fashion and had a similar performance for the diagnosis of rectosigmoid endometriosis, although CTC was more accurate in diagnosing and characterizing sigmoid nodules.

A prospective study comparing rectal water contrast‐transvaginal ultrasonography with sonovaginography for the diagnosis of deep posterior endometriosis

“…Several studies showed that RWC-TVS is accurate in diagnosing rectosigmoid endometriosis, and its performance has been compared to other radiological exams, such as multidetector computerized tomography enema (MDCT-e), CTC, and MR-enema (10,11,14,22).…”

“…Images were acquired with 3D multiplanar mode and rendering mode; two specific quality enhancement tools, advanced Speckle Reduction Imaging (SRI) and CrossXBeamCRI TM (GE Medical Systems), were applied during 3D rendering. On the 3D rendering, DE lesions typically appear as spiculated lesions with a retracting line all around the nodule (22). The nodules' volume was estimated using virtual organ computer-aided analysis (VOCAL; GE Medical Systems), specifically, obtaining a sequence of 20 sections of each endometriotic nodule around a fixed axis, each after 9° rotation from the previous section.…”

“…This article is protected by copyright. All rights reserved might be more precise in estimating the distance between the lowest endometriotic nodule and the anal verge, in particular, in case of upper rectosigmoid nodules (10,22). Lastly, the degree of intestinal stenosis due to endometriotic nodules may be estimated by RWC-TVS (22); preoperative estimation of the stenosis of bowel lumen may be helpful not only during the preoperative surgical planning but also in infertile women who may have a higher risk of bowel occlusion during ovarian stimulation and pregnancy to evaluate the need of surgical treatment (30).…”

“…In our study, 3D reconstruction was employed during the enhanced ultrasonographic exams; these acquisitions have been investigated for characterizing DE nodules, as they have a wide spatial orientation and allow to obtain a range of different displays of the images in the three orthogonal planes (37). Moreover, 3D acquisitions, being assessed off-line by a dedicated postprocessing software, can be manipulated, rotated, or scrolled through in fascinating virtual navigation (22). It has been recently reported that 3D reconstruction of the coronal plane may allow for better visualization of pelvic structures, such as the posterior vaginal fornix and rectovaginal septum (38).…”

BIRC5/Survivin Expression as a Non-Invasive Biomarker of Endometriosis

“…Indeed, according to guidelines of the European Society of Human Reproduction and Embryology (ESHRE), clinicians are recommended not to use immunological biomarkers, including CA125, in plasma, urine, or serum to diagnose endometriosis [ 6 ]. Despite considerable efforts towards searching for noninvasive diagnostic methods to detect endometriosis, the diagnosis can be suspected by ultrasound and/or other imaging methods [ 7 ] and confirmed only through laparoscopy with inspection of the abdominal cavity and histological confirmation of the lesion(s) [ 1 , 3 ]. As the surgery presents risks and also a high cost, a less invasive, but accurate test could lead to the diagnosis of the disease without the need for surgery, or at least it could help reduce the need for a surgical procedure for its confirmation [ 3 ].…”