MRI of endometriosis in correlation with the #Enzian classification: applicability and structured report

Maciel, Cristina; Ferreira, Hélder; Djokovic, Dusan; Tun, Jimmy Kyaw; Keckstein, J.; Rizzo, Stefania; Manganaro, Lucia

doi:10.1186/s13244-023-01466-x

Cited by 8 publications

(2 citation statements)

References 46 publications

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“…Moreover, due to the volume of the rectal probe, the percentage of stenosis of the digestive lumen needed to be <50%. With the MRI, we were also able to identify other areas of deep endometriosis involvement, whether posterior (uterosacral ligaments, torus uterinum , vagina, parametrium) or surrounding the bladder, using MRI ENZIAN ( Maciel et al , 2023 ).…”

Section: Methodsmentioning

confidence: 99%

Evaluating the safety of high-intensity focused ultrasound treatment for rectal endometriosis: results from a French prospective multicentre study including 60 patients

Dubernard,

Maissiat,

Legendre

et al. 2024

Human Reproduction

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STUDY QUESTION Is increasing the intensity of high-intensity focused ultrasound (HIFU) by 30% in the treatment of rectal endometriosis a safe procedure? SUMMARY ANSWER This study demonstrates the safety of a 30% increase in the intensity of HIFU in the treatment of rectal endometriosis, with no Clavien–Dindo Grade III complications overall, and namely no rectovaginal fistulae. WHAT IS KNOWN ALREADY A feasibility study including 20 patients with rectal endometriosis demonstrated, with no severe complications, a significant improvement in digestive disorders, dysmenorrhoea, dyspareunia, and health status, although the volume of the endometriosis nodule did not appear to be reduced. STUDY DESIGN, SIZE, DURATION A prospective multicentre cohort study was conducted between 2020 and 2022 with 60 patients with symptomatic rectal endometriosis. Following the failure of medical treatment, HIFU treatment was offered as an alternative to surgery. PARTICIPANTS/MATERIALS, SETTING, METHODS As the main objective of this study was to examine safety, all adverse events observed during the 6 months of follow-up were analysed and graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) and Clavien–Dindo classifications. Secondary objectives included evaluating the evolution of symptoms using validated questionnaires: gynaecological and digestive pain symptoms with a visual analogue scale, health status with the Medical Outcomes Study 36-item Short Form (SF-36) questionnaire, average post-operative daily pain level, and analgesic medication required in the 10 days following treatment. MRI was also performed at Day 1 to detect early complications. Finally, we performed a blinded MRI review of the evolution of the nodule at 6 months post-treatment. MAIN RESULTS AND THE ROLE OF CHANCE The procedure was performed under spinal anaesthesia for 30% of the patients. The median duration of treatment was 32 min. Fifty-five patients left the hospital on Day 1. MRI scans performed on Day 1 did not highlight any early-onset post-operative complication. Using the Clavien–Dindo classification, we listed 56.7% Grade I events, 3.4% Grade II events, and no events Grade III or higher. At 1, 3, and 6 months, all gynaecologic, digestive and general symptoms, as well as health status, had significantly improved. The evolution of the nodule was also significant (P < 0.001) with a 28% decrease in volume. LIMITATIONS, REASONS FOR CAUTION The main objective was safety and not effectiveness. The study was not randomized and there was no control group. WIDER IMPLICATIONS OF THE FINDINGS HIFU treatment for rectal endometriosis results in an improvement of symptoms with low morbidity; as such, for selected patients, it could be a valuable alternative to surgical approaches following the failure of medical treatment. STUDY FUNDING/COMPETING INTEREST(S) The study was funded by the company EDAP TMS. Professors Dubernard and Rousset are consultants for EDAP TMS. Dubernard received travel support from EDAP-TMS. Dr F. Chavrier received industrial grants from EDAP-TMS. He has developed a device for generating focused ultrasonic waves with reduced treatment time. This device has been patented by EDAP-TMS. Dr Lafon received industrial grants from EDAP-TMS; he declares that EDAP-TMS provided funding directly to INSERM to support a young researcher chair in therapeutic ultrasound, which is unrelated to the current study. TRIAL REGISTRATION NUMBER ClinicalTrials.gov identifier NCT04494568.

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Section: Methodsmentioning

confidence: 99%

Evaluating the safety of high-intensity focused ultrasound treatment for rectal endometriosis: results from a French prospective multicentre study including 60 patients

Dubernard,

Maissiat,

Legendre

et al. 2024

Human Reproduction

View full text Add to dashboard Cite

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“…дослідити субтипи глибокого ендометріозу, частоту та варіанти їх поєднання за результатами хірургічного лікування жінок із глибоким ендометріозом. [4,11,12,13,14,15]. Результати за трансвагінальним УЗД, МРТ описані згідно IDEA 2016, MUSA [5,18].…”

Section: метаunclassified

Subtypes of Deep Endometriosis According to Laparoscopic Revision

GLADCHUK,

HAIDARZHI

2023

AAGU

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A detalied description of the various manifestation of deep endometriosis should be reflected in classification #Enzian, which requires clinicians to understand the anatomical polymorphism of the disease. The purpose of the work is to explore the types of anatomical polymorphism of deep endometriosis, frequency and options for their combination to determine the main and rare subtypes of the disease. Materials and research methods. Deep endometriosis in 98% of cases is a polymorphic disease with a combination of peritoneal and ovarian endometriosis, and in 91.3% of women it is accompanied by adhesions of the pelvic organs of varying severity; in 2% of patients, deep endometriosis is an isolated form with severe damage to hollow organs; this requires proper preparation for surgical intervention in such patients with the involvement of a multidisciplinary team. Research results. Conclusions. Analysis of the identified subtypes in the future will form the basis for the development of an algorithm for standardized surgical intervention to improve the results of surgical treatment of deep endometriosis.

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MRI of pelvic endometriosis: evaluation of the mr#Enzian classification and the importance of adenomyosis subtypes

Pausch,

Filleböck,

Benli

et al. 2024

Abdom Radiol

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Purpose This study aimed to investigate the utility of the #Enzian classification in magnetic resonance imaging (MRI) for endometriosis assessment, focusing on inter-reader agreement, diagnostic accuracy, and the correlation of adenomyosis with deep endometriosis (DE). Methods This IRB- approved retrospective single-center study included 412 women who underwent MRI evaluation for endometriosis between February 2017 and June 2022. Two experienced radiologists independently analyzed MRI images using the #Enzian classification and assessed the type of adenomyosis, if any. The surgical #Enzian classification served as the gold standard for evaluating preoperative MRI results of 45 patients. Statistical analysis was performed to assess inter-reader agreement and diagnostic accuracy. Results Inter-reader agreement was substantial to excellent (Cohen’s kappa 0.75–0.96) for most compartments except peritoneal involvement (0.39). The preoperative MRI showed mostly substantial to excellent accuracy (0.84–0.98), sensitivity (0.62–1.00), specificity (0.87–1.00), positive (0.58–1.00) and negative predictive values (0.86–1.00) for most compartments, except for peritoneal lesions (0.36, 0.17, 1.00, 1.00, 0.26 respectively). A trend with a higher prevalence of concordant DE in women with MR features of external adenomyosis compared to those with internal adenomyosis was visible (p = 0.067). Conclusions The mr#Enzian showed mostly high inter-reader agreement and good diagnostic accuracy for various endometriosis compartments. MRI’s role is particularly significant in the context of the current paradigm shift towards medical endometriosis treatment. The inclusion of information about the type of adenomyosis in the mr#Enzian classification could enhance diagnostic accuracy and inform treatment planning. Graphical Abstract

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MRI of endometriosis in correlation with the #Enzian classification: applicability and structured report

Cited by 8 publications

References 46 publications

Evaluating the safety of high-intensity focused ultrasound treatment for rectal endometriosis: results from a French prospective multicentre study including 60 patients

Evaluating the safety of high-intensity focused ultrasound treatment for rectal endometriosis: results from a French prospective multicentre study including 60 patients

Subtypes of Deep Endometriosis According to Laparoscopic Revision

MRI of pelvic endometriosis: evaluation of the mr#Enzian classification and the importance of adenomyosis subtypes

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