Association between kissing and retropositioned ovaries and severity of endometriosis: MR imaging evaluation

Williams, Jamie C.; Burnett, Tatnai L.; Jones, T.L.; Venkatesh, Sudhakar K.; VanBuren, Wendaline M.

doi:10.1007/s00261-019-02153-6

Cited by 16 publications

(6 citation statements)

References 12 publications

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“…In a prospective study including 201 women, Holland et al ( 2010 ) found good agreement between TVS findings and the surgical rASRM stage (absent, minimal, mild, moderate, and severe endometriosis; quadratic weighted kappa = 0.786). In a small cohort study including 65 patients Williams et al ( 2020 ) demonstrated that kissing ovaries and retropositioned ovaries on pre-operative MRI were associated with high intra-operative rASRM stages of endometriosis.…”

Section: The Rasrm Scorementioning

confidence: 99%

What to choose and why to use – a critical review on the clinical relevance of rASRM, EFI and Enzian classifications of endometriosis

Hudelist¹,

Valentin²,

Sarıdoğan³

et al. 2021

Facts Views Vis ObGyn

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Background: Endometriosis is a common benign gynaecological disease that affects pelvic structures and causes adhesions. Endometriosis outside the pelvis exists but is rarer. Deep endometriosis may affect organs such as the urinary bladder, ureters, bowel and sacral roots. Adenomyosis (growth of endometrium in the myometrium, sometimes explained by disruption of the uterine junctional zone) frequently co-exists with deep endometriosis. Over the past decades, multiple attempts have been made to describe the anatomical extent of endometriosis. Out of approximately 20 classification systems suggested and published so far, three have gained widespread acceptance. These are the rASRM (American Society of Reproductive Medicine) classification, the Endometriosis Fertility Index (EFI) and the Enzian classification. Ideally, a classification system should be useful both for describing disease extent based on surgical findings and results of imaging methods (ultrasound, magnetic resonance imaging). Objectives: To highlight the advantages and disadvantages of the three classification systems. Methods: This is a narrative review based on selected publications and experience of the authors. We discuss the current literature on the use of the rASRM, EFI and Enzian classification systems for describing disease extent with imaging methods and for prediction of fertility, surgical complexity, and risk of surgical complications. We underline the need for one universally acceptable terminology to describe the extent of endometriosis. Conclusions: A useful classification system for endometriosis should describe the sites and extent of the disease, be related to surgical complexity and to disease-associated symptoms, including subfertility and should satisfy needs of both, imaging specialists for pre-operative classification and surgeons. The need for such a system is obvious and is provided by the #Enzian classification. Future research is necessary to test its validity.

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Section: The Rasrm Scorementioning

confidence: 99%

What to choose and why to use – a critical review on the clinical relevance of rASRM, EFI and Enzian classifications of endometriosis

Hudelist¹,

Valentin²,

Sarıdoğan³

et al. 2021

Facts Views Vis ObGyn

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“…In the present study, as in previous reports, CCC and EC had a high endometriosis complication rate of > 70%. In endometriosis, inflammation occurs in the cul-de-sac, uterosacral ligaments, and ovaries, and chronic cyclical inflammation leads to the formation of adhesions that tether the ovaries to the posterior uterus [ 18 , 19 ]. On MRI, retropositioned ovaries, which means both ovaries positioned posterior to the cornua of the uterus, appearing adherent to the uterine serosa but not in contact with each other, and kissing ovaries, which means both ovaries in contact in addition to the retropositioned ovaries, are associated with higher intraoperative Revised American Society for Reproductive Medicine classification system endometriosis stages [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Differences in the position of endometriosis-associated and non-associated ovarian cancer relative to the uterus

et al. 2023

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Background Preoperative assessment of the histological type of ovarian cancer is essential to determine the appropriate treatment strategy. Tumor location may be helpful in this regard. The purpose of this study was to compare the position of endometriosis-associated (EAOCs) and non-associated (non-EAOCs) ovarian cancer relative to the uterus using MRI. Methods This retrospective study included patients with pathologically confirmed malignant epithelial ovarian tumors who underwent MRI at our hospital between January 2015 and January 2023. T2-weighted images of the sagittal and axial sections of the long axis of the uterine body were used for the analysis. Three blinded experienced radiologists independently interpreted the images and assessed whether the ovarian tumor was attached to the uterus, and the angle between the uterus and the tumor was measured. The presence of attachment and the measured angles were compared for each histology. In addition, the angles between EAOCs, including endometrioid carcinomas (ECs) and clear cell carcinomas (CCCs), were compared with non-EAOCs. Results In total, 184 women (mean age, 56 years; age range, 20–91 years) were evaluated. High-grade serous carcinomas (HGSCs) were significantly smaller than the others and had significantly less uterine attachment than CCCs (p < 0.01 for all readers). According to the mean of the measured angles, CCCs were positioned significantly more posteriorly than HGSCs and mucinous carcinomas (p < 0.02), and EAOCs were positioned significantly more posteriorly to the uterus than non-EAOCs (p < 0.01). Conclusion HGSCs are often not attached to the uterus, and EAOCs are positioned more posteriorly to the uterus than non-EAOCs. Critical relevance statement High-grade serous carcinomas were often not attached to the uterus, and endometriosis-associated ovarian cancers were positioned more posteriorly to the uterus than non-endometriosis-associated ovarian cancers. Key points • The position of the ovarian tumor can be determined using MRI. • High-grade serous carcinomas had less attachment to the uterus. • Endometriosis-associated cancers were positioned more posteriorly to the uterus. • The location of ovarian tumors is helpful in estimating histology. Graphical abstract

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“…US examination has revealed that this finding is strongly related to disease severity, frequency of infertility, and operation time [ 74 ]. Kissing ovaries and retropositioned ovaries (ovaries located behind the uterus) on MRI show a significant correlation with DIE (sensitivity, 67%; specificity, 68%; PPV, 55% in the detection of DIE) [ 75 ]. As Williams et al [ 75 ] described, ovaries are anchored in position by three structures: the mesovarium, utero-ovarian ligaments, and suspensory ligaments.…”

Section: Mri Findings Of Deeply Infiltrating Endometriosismentioning

confidence: 99%

“…Kissing ovaries and retropositioned ovaries (ovaries located behind the uterus) on MRI show a significant correlation with DIE (sensitivity, 67%; specificity, 68%; PPV, 55% in the detection of DIE) [ 75 ]. As Williams et al [ 75 ] described, ovaries are anchored in position by three structures: the mesovarium, utero-ovarian ligaments, and suspensory ligaments. Kissing ovaries result from the distortion of these anchoring structures following intense inflammation and fibrotic changes stimulated by endometriosis [ 75 ].…”

Section: Mri Findings Of Deeply Infiltrating Endometriosismentioning

confidence: 99%

“…As Williams et al [ 75 ] described, ovaries are anchored in position by three structures: the mesovarium, utero-ovarian ligaments, and suspensory ligaments. Kissing ovaries result from the distortion of these anchoring structures following intense inflammation and fibrotic changes stimulated by endometriosis [ 75 ].…”

Section: Mri Findings Of Deeply Infiltrating Endometriosismentioning

confidence: 99%

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MRI in the Diagnosis of Endometriosis and Related Diseases

et al. 2022

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Endometriosis, a common chronic inflammatory disease in female of reproductive age, is closely related to patient symptoms and fertility. Because of its high contrast resolution and objectivity, MRI can contribute to the early and accurate diagnosis of ovarian endometriotic cysts and deeply infiltrating endometriosis without the need for any invasive procedure or radiation exposure. The ovaries, which are the most frequent site of endometriosis, can be afflicted by multiple related conditions and diseases. For the diagnosis of deeply infiltrating endometriosis and secondary adhesions among pelvic organs, fibrosis around the ectopic endometrial gland is usually found as a T2 hypointense lesion. This review summarizes the MRI findings obtained for ovarian endometriotic cysts and their physiologically and pathologically related conditions. This article also includes the key imaging findings of deeply infiltrating endometriosis.

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Association between kissing and retropositioned ovaries and severity of endometriosis: MR imaging evaluation

Cited by 16 publications

References 12 publications

What to choose and why to use – a critical review on the clinical relevance of rASRM, EFI and Enzian classifications of endometriosis

What to choose and why to use – a critical review on the clinical relevance of rASRM, EFI and Enzian classifications of endometriosis

Differences in the position of endometriosis-associated and non-associated ovarian cancer relative to the uterus

MRI in the Diagnosis of Endometriosis and Related Diseases

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