MRI impacts endometriosis management in the setting of image-based multidisciplinary conference: a retrospective analysis

Burkett, Brian J.; Cope, Adela G.; Bartlett, David J.; Burnett, Tatnai L.; Jones, T.L.; Venkatesh, Sudhakar K.; VanBuren, Wendaline M.

doi:10.1007/s00261-020-02417-6

Cited by 6 publications

(3 citation statements)

References 9 publications

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“…One good example is represented by the study of Burkett et al [ 41 ], in which they aimed to quantify the value of pre-operative MRI in the management of women suffering from endometriosis. Out of one hundred and thirty-six patients, the associated methodology needs to be changed in 18.4% of the cases ( n = 25).…”

Section: Discussionmentioning

confidence: 99%

Abdominal Wall Endometriosis: Two Case Reports and Literature Review

Doroftei

Armeanu²,

Maftei

et al. 2020

Medicina

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Background and objectives: Abdominal wall endometriosis, also known as scar endometriosis, is a rare condition that is becoming increasingly common. The recent rise in incidence is attributed primarily to the surge of cesarean births, figures that could be influenced in a positive manner considering the improvements brought towards the ultrasound diagnostic methods that have been made in recent years. Materials and Methods: Here we report the cases of two Caucasian women of 38- (G2P2) and 36-years old (G1P1), both subjected to an ultrasound examination due to a specific symptomatic panel reported during anamnesis. Independently of the current status, in the first patient, there were no reported symptom-specific associations with endometriosis, but she had a known history of mild hereditary thrombophilia; the second woman suffered from two conditions positively associated with endometriosis. Results: In both cases, abnormal structures were revealed, with the diagnostic(s) of endometriosis being histologically confirmed based on a set of features observed during the investigation. Conclusions: This paper aims to highlight the importance of reducing cesarean births and to consider the diagnosis of scar endometriosis in women with a history of obstetric or gynaecological surgeries who present with cyclic, recurrent abdominal pain.

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Section: Discussionmentioning

confidence: 99%

Abdominal Wall Endometriosis: Two Case Reports and Literature Review

Doroftei

Armeanu²,

Maftei

et al. 2020

Medicina

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“…17,18 All MRIs underwent interdisciplinary conference review with a team of gynecologists and radiologists. 19 The radiologists reviewed imaging prior to the discussion of the clinical picture at the interdisciplinary conference. DE was considered to be in the posterior compartment if it was identified involving the rectosigmoid colon, uterosacral ligaments, posterior cul de sac, and/or pelvic side walls.…”

Section: Methodsmentioning

confidence: 99%

Gastrointestinal symptoms as a predictor of deep endometriosis of the pelvic posterior compartment on magnetic resonance imaging

Fadadu

Cope

Weng

et al. 2022

Journal of Endometriosis and Pelvic Pain Disorders

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Objective: To determine if gastrointestinal (GI) symptoms can predict deep endometriosis (DE) of the posterior pelvic compartment on magnetic resonance imaging (MRI). Methods: Patients with suspected endometriosis undergoing endometriosis protocol MRI at an academic center between 9/1/2015 and 7/31/2018 were identified. Presenting GI symptoms were collected via a standardized survey instrument prospectively at initial presentation. MRI and interdisciplinary conference notes were reviewed to identify posterior compartment DE (rectosigmoid, uterosacral ligaments, posterior cul de sac, and pelvic side walls). Associations between symptoms and DE were evaluated. Results: A total of 104 patients met inclusion criteria, and 89 (85.6%) presented with at least one GI symptom. Posterior compartment DE was identified on MRI in 47 patients (45.2%). The GI symptom that most strongly predicted DE was a bowel movement resulting in pain relief (OR 3.36, 95% CI 1.31–8.61, p = 0.012), with sensitivity, specificity, positive and negative predictive values 0.42, 0.82, 0.67, and 0.63, respectively. Other GI symptoms such as nausea, vomiting, rectal bleeding, change in frequency of bowel movements, and pain exacerbation by bowel movements did not significantly correlate to having DE. Of the 15 patients with no GI symptoms, 5 were found to have posterior compartment DE. Conclusion: In patients with suspected endometriosis, those who noted that bowel movements relieved their pain had more than three times the odds of having DE of the posterior compartment on MRI. Preoperative evaluation with MRI may be of value in these patients; however, lack of gastrointestinal symptoms does not exclude the possibility of posterior compartment DE.

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“…14 This mode of imaging may aid peripheral hospitals in preoperative planning and triage, especially as images can be acquired and interpreted remotely. 15,16…”

Section: Clinical Utilitymentioning

confidence: 99%

MRI sliding sign: Using MRI to assess rectouterine mobility in pelvic endometriosis

et al. 2021

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Introduction: Surgical excision of deep infiltrating endometriosis (DIE) is complex and associated with morbidity. Diagnostic imaging plays an important role in the preoperative workup. We sought to determine the utility of single sagittal T2-weighted MRI motion sequence in the preoperative assessment of pelvic mobility in patients with endometriosis. Methods: An observational study at a single tertiary public referral centre in Australia. Eighty-one MRI studies from 1 May 2019 to 3 December 2019, were enrolled. Studies were included if they were performed to stage endometriosis, including a T2-weighted motion series, adequately covering a uterus, cervix and rectum. Fifty-seven studies met inclusion criteria. The reference standard was a contemporaneous transvaginal ultrasound (TVUS) reporting on pelvic organ mobility. Three subspecialist radiologists were then blindly asked to identify, on the cine loop: rectouterine immobility, superficial endometriosis (pelvic bowel adhesions), rectosigmoid Deep Infiltrating Endometriosis (DIE). Fleiss' Kappa assessed interobserver agreement. Consensus MRI sensitivity and specificity were estimated against the reference standard (TVUS). Results: Median age was 35 years (range 19-51). Forty-three cases had a contemporaneous TVUS; 14 reporting a sliding sign, 29 with fixed pelves. Interobserver agreement was 'substantial' (k = 0.79) for absent MRI sliding sign and 'almost perfect' (k = 0.90) for absence of DIE. Consensus MRI had 90% sensitivity (95% CI 73-98%) for pelvic immobility at TVUS (absent sliding sign). Interobserver agreement and consensus MRI sensitivity were higher for adhesions and immobility than normal findings. Conclusion: An MRI motion sequence can identify patients with pelvic adhesions and immobility, helping determine surgical difficulty when TVUS is not diagnostic.

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MRI impacts endometriosis management in the setting of image-based multidisciplinary conference: a retrospective analysis

Cited by 6 publications

References 9 publications

Abdominal Wall Endometriosis: Two Case Reports and Literature Review

Abdominal Wall Endometriosis: Two Case Reports and Literature Review

Gastrointestinal symptoms as a predictor of deep endometriosis of the pelvic posterior compartment on magnetic resonance imaging

MRI sliding sign: Using MRI to assess rectouterine mobility in pelvic endometriosis

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