Magnetic Resonance Colonography May Predict the Need for Bowel Resection in Colorectal Endometriosis

Abstract

Purpose To define if MRI findings in patients with deep pelvic endometriosis (DPE) may be predictive for the need of bowel resection. Material and Methods A retrospective survey of 196 pelvic MRIs of women who received laparoscopic procedures for DPE was carried out. A pelvic MRI was performed in all patients: it consisted in T2w-TSE sequences in axial, sagittal, and coronal planes and T1w and THRIVE sequences in the axial plane; the exam was completed by MR-Colonography. Intestinal lesions were measured in short and long axis and the degree of stenosis was established. A multivariate logistic regression was used to identify the predictors of intestinal resection. Results 57/196 patients received an intestinal resection. Multivariate logistic regression demonstrated a predictive value of short axis (Odds-Ratio = 2.29, p = 0.011) and stenosis (Odds-Ratio = 1.20, p = 0.003). ROC analysis showed that a cut-off value of 11 mm for the short axis and 30% for the stenosis may correctly classify, respectively, 96,94% (sensitivity 92,9% and specificity 98,56%) and 97,96% (sensitivity 94,74% and specificity 99,3%) of the cases. Conclusion The presence of an endometriotic rectal nodule > 11 mm in short axis causing a stenosis > 30% in pelvic MRI reliably predicts the need of a rectal resection.

Preoperative rectosigmoid endoscopic ultrasonography predicts the need for bowel resection in endometriosis

“…Regarding MRI, our study completes the recent findings concerning MRI measures of stenosis and long axis to predict the need for bowel resection In this study, a nodule’s short axis of 11 mm or more was a predictor for bowel resection with a sensitivity and a specificity of 93% and 99% respectively. Similarly, a bowel stenosis of 30% or more experienced a sensitivity of 95% and a specificity of 99% in predicting the need for a bowel resection[9]. Nevertheless, MRI colonography was a required parameter of this study, and this technique is only available in a limited number of centers.…”

“…A recent study has shown that a pre-operative MRI-colonography might predict the need for bowel resection in recto-sigmoid endometriosis[9]. However, it has previously been demonstrated that RS-EUS exhibits better sensitivity and negative predictive value than MRI in the diagnosis of rectosigmoid endometriosis[10].…”

Differential Diagnosis of Endometriosis by Ultrasound: A Rising Challenge

“…Colonic endometriosis is not a rare condition. It affects 37% of women with severe endometriosis [ 13 ], and its correct diagnosis is essential for the proper planning of treatment [ 15 , 48 , 50 , 51 ]. Recently, the ultrasound detection rate of endometriosis foci of the bowels has increased, exhibiting both high sensitivity and specificity [ 46 , 52 ].…”

Magnetic resonance imaging for deep infiltrating endometriosis: current concepts, imaging technique and key findings

“…A systematic sonographic approach as defined by International Deep Endometriosis Analysis (IDEA) consensus was shown to improve detection rates of pelvic lesions [ 24 ]. MRI is also considered a highly accurate imaging modality in the evaluation of DIE, particularly when involvement of the rectum, ureters and nerve roots is suspected; these areas are highly important for both the patient and the surgeon and may be poorly visualized even with laparoscopy [ 25 , 26 ]. MRI is also increasingly used to assess the anatomic response to medical or surgical treatment and to differentiate endometriosis from adenomyosis; the latter is a specific and heterogeneous disease contributing, independently of endometriosis to symptoms, defined as the invasion of endometrial tissue into the myometrium occurring in different forms (diffuse, focal, cystic or superficial).…”