Endometriosis: Appearance and detection with conventional and contrast‐enhanced fat‐suppressed spin‐echo techniques

Abstract

Suspected pelvic endometriosis was prospectively evaluated in 31 women with T1-and T2-weighted conventional spin-echo (CSE) magnetic resonance imaging alone and in combination with T1-weighted fat-suppressed (TlFS) and gadolinium-enhanced TlFS (GI-TlFS) spin-echo techniques. Images were grouped for interpretation and comparison as follows: [a) CSE alone, @) CSE/TlFS, and (c) CSE/TlFS/ GI-TlFS. AU patients underwent surgery within 3 months of imaging, and 21 patients were found to have endometriosis: 59 endometriomas (26 large and 33 small) and 51 sites of implants were seen. With CSE images. 23 large and six small endometriomas were detected. With CSE/TlFS images. 25 large and 14 small endometriomas were identified. With CSE/ TlFS/Gd-TlFS images. 24 large and 14 small endometriomas were detected and ill-detlned areas of enhancement were noted in 22 sites throughout the pelvis. These corresponded to endometriotic implants seen at surgery in 14 sites. The sensitivity, specificity. and accuracy, respectively. for the detection of endometriosis were 76%. 60%. and 71% for CSE, 86%. 50%. and 74% for CSE/TlFS, and 81%, 50%. and 71% for CSE/TlFS/Gd-TlFS images.No significant differences (P > .l) between image combinations for correctly identifying patients with and without endometriosis were seen. The difference in sensitivity between CSE and CSE/TlFS and between CSE and CSE/TlFS/Gd-TlFS images for detecting smaU endometriomas was significant (P = .03).

Three-Dimensional Dynamic MR-Hysterosalpingography: A New, Low Invasive, Radiation-Free and Less Painful Radiological Approach to Female Infertility

“…At present, MRI is the most accurate method for the noninvasive diagnosis of various pelvic pathologies (Dudiak et al, 1988;Carrington et al, 1990;Dykes et al, 1991;Mitchell 1992;Pellerito et al, 1992;Woodward et al, 1993;Ascher et al, 1995). Due to an excellent resolution, direct visualization of the reproductive organs, multiplanar imaging and avoidance of radiation, MRI is therefore used worldwide as an additional examination in the evaluation of female infertility.…”

“…© European Society of Human Reproduction and Embryology high accuracy in detecting various pelvic, uterine and ovarian pathologies (Philipsen, Hansen, 1981;Dudiak et al, 1988;Carrington et al, 1990;Dykes et al, 1991;Mitchell, 1992;Pellerito et al, 1992;Woodward et al, 1993;Ascher et al, 1995). Furthermore it could be shown that imaging the uterine cavity and Fallopian tube patency is possible by MR-HSG but until now, direct visualization of the Fallopian tubes could not be achieved by MR-HSG (Lee et al, 1996;Frye et al, 2000;Hagspiel et al, 2000;Rouanet et al, 2000;Wiesner et al, 2001).…”

Secondary Tumors and Tumorlike Lesions of the Peritoneal Cavity: Imaging Features with Pathologic Correlation

“…Use of fat-suppressed and chemical-shift imaging techniques improves the conspicuity and detection rate of peritoneal disease and small endometriomas (67,68). Use of gadolinium-based contrast material does not add specificity to the diagnosis of endometriosis with MR imaging because the enhancement patterns are nonspecific and overlap with those of other benign and malignant processes (69).…”

Three-dimensional dynamic MR hysterosalpingography: a preliminary report

“…Three-dimensional dynamic MR HSG as performed in our patients demonstrates clearly the anatomy of the cavum uteri, and if further improvement can be made on this technique, it could evolve into a feasible alternative to conventional hysterosalpingography [3,4]. Compared with conventional hysterosalpingography, 3D dynamic MR HSG provides additional information about the myometrium and the ovaries and may improve the diagnosis of uter- ine malformations, tumors, or endometriosis where the value of MRI is already generally accepted [5,6,7,8,9]. Regarding reconstruction techniques, we could not find a real advantage of surface rendering over maximum intensity projections in visualizing fallopian tube patency, and both reconstruction methods seem to be of the same value in demonstrating the anatomy of a normal uterine cavity.…”