The Role of Computed Tomography Colonography in Detecting Bowel Involvement in Women With Deep Infiltrating Endometriosis

Baggio, Silvia; Zecchin, Alessandro; Pomini, Paola; Zanconato, Giovanni; Genna, Michele; Motton, Massimiliano; Montemezzi, Stefania; Franchi, Massimo Piergiuseppe

doi:10.1097/rct.0000000000000447

Cited by 15 publications

(14 citation statements)

References 27 publications

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“…The full texts of the remaining 133 articles were reviewed, of which 88 were excluded as they did not meet the inclusion criteria or had overlapping study populations. Of the remaining 45 eligible studies, 30 23–52 specifically assessed the rectum/rectosigmoid and were included in the analysis. A list of excluded studies is provided in Appendix S3.…”

Section: Resultsmentioning

confidence: 99%

“…Of the 30 studies, 22 were conducted in Europe, five in South America, one in Australia, one in Asia and one in the Middle East. A total of 21 (2857 patients, with 3055 examinations included in the analysis due to some studies comparing more than one TVS technique in the same patients 37,50 ) studies assessed TVS, of which 13 (2002 patients) used standard 2D-TVS 24,25,28,[36][37][38][40][41][42]44,45,48,50 , five (502 patients) assessed TVS with rectal water contrast (RWC) 27,30,34,51,52 , one used TVS with gel contrast 43 , one assessed three dimensional (3D)-TVS 37 and three assessed TVS with BP 23,49,50 . A total of seven studies assessed MRI (852 patients), of which one compared standard 2D-and 3D-MRI 29 , one compared MRI with and without rectal ultrasound gel 39 and the remainder assessed standard 2D-MRI only (with standard 2D-MRI assessed in 813 patients overall) 23,24,28,32,37 .…”

Section: Search Resultsmentioning

confidence: 99%

“…A total of seven studies assessed MRI (852 patients), of which one compared standard 2D-and 3D-MRI 29 , one compared MRI with and without rectal ultrasound gel 39 and the remainder assessed standard 2D-MRI only (with standard 2D-MRI assessed in 813 patients overall) 23,24,28,32,37 . Six studies (402 patients) assessed CT, of which three assessed standard CT 31,47,51 and three assessed CT colonography 25,27,34 . Eight (850 patients) studies assessed RES 24,26,28,30,33,35,44,46 and three used double-contrast barium enema (DCBE) 32,46,52 .…”

Section: Search Resultsmentioning

confidence: 99%

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Optimal imaging modality for detection of rectosigmoid deep endometriosis: systematic review and meta‐analysis

Gerges

Leonardi

et al. 2021

Ultrasound in Obstet & Gyne

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Objectives To review the accuracy of different imaging modalities for the detection of rectosigmoid deep endometriosis (DE) in women with clinical suspicion of endometriosis, and to determine the optimal modality. Methods A search was conducted using PubMed, MEDLINE, Scopus, EMBASE and Google Scholar to identify studies using imaging to evaluate women with suspected DE, published from inception to May 2020. Studies were considered eligible if they were prospective and used any imaging modality to assess preoperatively for the presence of DE in the rectum/rectosigmoid, which was then correlated with the surgical diagnosis as the reference standard. Eligibility was restricted to studies including at least 10 affected and 10 unaffected women. The QUADAS‐2 tool was used to assess the quality of the included studies. Mixed‐effects diagnostic meta‐analysis was used to determine the overall pooled sensitivity and specificity of each imaging modality for rectal/rectosigmoid DE, which were used to calculate the likelihood ratio of a positive (LR+) and negative (LR–) test and diagnostic odds ratio (DOR). Results Of the 1979 records identified, 30 studies (3374 women) were included in the analysis. The overall pooled sensitivity and specificity, LR+, LR– and DOR for the detection of rectal/rectosigmoid DE using transvaginal sonography (TVS) were, respectively, 89% (95% CI, 83–92%), 97% (95% CI, 95–98%), 30.8 (95% CI, 17.6–54.1), 0.12 (95% CI, 0.08–0.17) and 264 (95% CI, 113–614). For magnetic resonance imaging (MRI), the respective values were 86% (95% CI, 79–91%), 96% (95% CI, 94–97%), 21.0 (95% CI, 13.4–33.1), 0.15 (95% CI, 0.09–0.23) and 144 (95% CI, 70–297). For computed tomography, the respective values were 93% (95% CI, 84–97%), 95% (95% CI, 81–99%), 20.3 (95% CI, 4.3–94.9), 0.07 (95% CI, 0.03–0.19) and 280 (95% CI, 28–2826). For rectal endoscopic sonography (RES), the respective values were 92% (95% CI, 87–95%), 98% (95% CI, 96–99%), 37.1 (95% CI, 21.1–65.4), 0.08 (95% CI, 0.05–0.14) and 455 (95% CI, 196–1054). There was significant heterogeneity and the studies were considered methodologically poor according to the QUADAS‐2 tool. Conclusions The sensitivity of TVS for the detection of rectal/rectosigmoid DE seems to be slightly better than that of MRI, although RES was superior to both. The specificity of both TVS and MRI was excellent. As TVS is simpler, faster and more readily available than the other methods, we believe that it should be the first‐line diagnostic tool for women with suspected DE. © 2020 International Society of Ultrasound in Obstetrics and Gynecology

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Section: Resultsmentioning

confidence: 99%

Section: Search Resultsmentioning

confidence: 99%

Section: Search Resultsmentioning

confidence: 99%

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Optimal imaging modality for detection of rectosigmoid deep endometriosis: systematic review and meta‐analysis

Gerges

Leonardi

et al. 2021

Ultrasound in Obstet & Gyne

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“…1 represents the selection of studies. Of the 45 ( Fedele et al , 1998 ; Dessole et al , 2003 ; Delpy et al , 2005 ; Takeuchi et al , 2005 ; Bahr et al , 2006 ; Abrao et al , 2007 ; Biscaldi et al , 2007 ; Guerriero et al , 2007 ; Griffiths et al , 2008 ; Guerriero et al , 2008 ; Ribeiro et al , 2008 ; Valenzano Menada et al , 2008 ; Bazot et al , 2009 ; Hottat et al , 2009 ; Hudelist et al , 2009 ; Piketty et al , 2009 ; Bergamini et al , 2010 ; Chassang et al , 2010 ; Faccioli et al , 2010 ; Goncalves et al , 2010 ; Grasso et al , 2010 ; Pascual et al , 2010 ; Ferrero et al , 2011 ; Hudelist et al , 2011 ; Fiaschetti et al , 2012 ; Savelli et al , 2012 ; Bazot et al , 2013 ; Holland et al , 2013 ; Hudelist et al , 2013 ; Manganaro et al , 2013 ; Stabile Ianora et al , 2013 ; Leon et al , 2014 ; Tammaa et al , 2015 ; Baggio et al , 2016 ; Menakaya et al , 2016 ; Ferrero et al , 2017 ; Guerriero et al , 2017 ; Jiang et al , 2017 ; Ros et al , 2017 ; Alborzi et al , 2018 ; Carfagna ...…”

Section: Resultsunclassified

Meta-analysis and systematic review to determine the optimal imaging modality for the detection of uterosacral ligaments/torus uterinus, rectovaginal septum and vaginal deep endometriosis

Gerges

Leonardi

et al. 2021

Human Reproduction Open

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STUDY QUESTION Is there an ideal imaging modality for the detection of uterosacral ligaments/torus uterinus (USL), rectovaginal septum (RVS) and vaginal deep endometriosis (DE) in women with a clinical history of endometriosis? SUMMARY ANSWER The sensitivity for the detection of USL, RVS and vaginal DE using MRI seems to be better than transvaginal ultrasonography (TVS), whilst the specificity of both were excellent. WHAT IS KNOWN ALREADY The surgical management of women with DE can be complex and requires advanced laparoscopic skills with maximal cytoreduction being vital at the first procedure to provide the greatest symptomatic benefit. Owing to a correlation of TVS findings with surgical findings, preoperative imaging has been used to adequately consent women and plan the appropriate surgery. However, until publication of the consensus statement by the International Deep Endometriosis Analysis Group in 2016, there were significant variations within the terms and definitions used to describe DE in the pelvis. STUDY DESIGN, SIZE, DURATION A systematic review and meta-analysis was conducted using Embase, Google Scholar, Medline, PubMed and Scopus to identify studies published from inception to May 2020, of which only those from 2010 were included owing to the increased proficiency of the sonographers and advancements in technology. PARTICIPANTS/MATERIALS, SETTING, METHODS All prospective studies that preoperatively assessed any imaging modality for the detection of DE in the USL, RVS and vagina and correlated with the reference standard of surgical data were considered eligible. Study eligibility was restricted to those including a minimum of 10 unaffected and 10 affected participants. MAIN RESULTS AND THE ROLE OF CHANCE There were 1977 references identified from which 10 studies (n = 1188) were included in the final analysis. For the detection of USL DE, the overall pooled sensitivity and specificity for all TVS techniques were 60% (95% CI 32–82%) and 95% (95% CI 90–98%), respectively, and for all MRI techniques were 81% (95% CI 66–90%) and 83% (95% CI 62–94%), respectively. For the detection of RVS DE, the overall pooled sensitivity and specificity for all TVS techniques were 57% (95% CI 30–80%) and 100% (95% CI 92–100%), respectively. For the detection of vaginal DE, the overall pooled sensitivity and specificity for all TVS techniques were 52% (95% CI 29–74%) and 98% (95% CI 95–99%), respectively, and for all MRI techniques were 64% (95% CI 40–83%) and 98% (96% CI 93–99%). Pooled analyses were not possible for other imaging modalities. LIMITATIONS, REASONS FOR CAUTION There was a low quality of evidence given the high risk of bias and heterogeneity in the included studies. There are also potential biases secondary to the risk of misdiagnosis at surgery owing to a lack of either histopathological findings or expertise, coupled with the surgeons not being blinded. Furthermore, the varying surgical experience and the lack of clarity regarding complete surgical clearance, thereby also contributing to the lack of histopathology, could also explain the wide range of pre-test probability of disease. WIDER IMPLICATIONS OF THE FINDINGS MRI outperformed TVS for the per-operative diagnosis of USL, RVS and vaginal DE with higher sensitivities, although the specificities for both were excellent. There were improved results with other imaging modalities, such as rectal endoscopy-sonography, as well as the addition of bowel preparation or ultrasound gel to either TVS or MRI, although these are based on individual studies. STUDY FUNDING/COMPETING INTEREST(S) No funding was received for this study. M.L. reports personal fees from GE Healthcare, grants from the Australian Women’s and Children’s Foundation, outside the submitted work. B.W.M. reports grants from NHMRC, outside the submitted work. G.C. reports personal fees from GE Healthcare, outside the submitted work; and is on the Endometriosis Advisory Board for Roche Diagnostics. REGISTRATION NUMBER Prospective registration with PROSPERO (CRD42017059872) was obtained.

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“…Previous studies investigated the performance of CTC in the diagnosis of bowel endometriosis [25,27,[32][33][34][35]. In a prospective study including 92 women undergoing surgery for deep infiltrating endometriosis, Baggio et al compared the diagnostic value of TVS, serum Ca125 and CTC [33]. Forty-nine subjects had rectosigmoid endometriosis.…”

Section: Discussionmentioning

confidence: 99%

A Prospective Study Comparing Three-Dimensional Rectal Water Contrast Transvaginal Ultrasonography and Computed Tomographic Colonography in the Diagnosis of Rectosigmoid Endometriosis

et al. 2020

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(1) Objectives: In patients with symptoms suggestive of rectosigmoid endometriosis, imaging techniques are required to confirm the presence and establish the extent of the disease. The objective of the current study was to compare the performance of three-dimensional rectal water contrast transvaginal ultrasonography (3D-RWC-TVS) and computed tomographic colonography (CTC) in predicting the presence and characteristics of rectosigmoid endometriosis. (2) Methods: This prospective study included patients with suspicion of rectosigmoid endometriosis who underwent both 3D-RWC-TVS and CTC and subsequently were surgically treated. The findings of imaging techniques were compared with surgical and histological results. (3) Results: Out of 68 women included in the study, 37 (48.9; 95% C.I. 38.2–59.7%) had rectosigmoid nodules and underwent bowel surgery. There was no significant difference in the accuracy of 3D-RWC-TVS and CTC in diagnosing the presence of rectosigmoid endometriotic nodules (p = 0.118), although CTC was more precise in diagnosing endometriosis located in the sigmoid (p = 0.016). 3D-RWC-TVS and CTC had similar precision in estimating the largest diameter of the main endometriotic nodule (p = 0.099) and, in patients undergoing segmental resection, the degree of the stenosis of the bowel lumen (p = 0.293). CTC was more accurate in estimating the distance between the lower margin of the intestinal nodule and the anal verge (p = 0.030) but was less tolerated than 3D-RWC-TVS (p < 0.001). (4) Conclusion: This was the first study comparing the performance of 3D-RWC-TVS and CTC in the diagnosis of rectosigmoid endometriosis. Both techniques allowed for the evaluation of the profile of the bowel lumen in a pseudoendoscopic fashion and had a similar performance for the diagnosis of rectosigmoid endometriosis, although CTC was more accurate in diagnosing and characterizing sigmoid nodules.

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The Role of Computed Tomography Colonography in Detecting Bowel Involvement in Women With Deep Infiltrating Endometriosis

Abstract: CTC proved to be an accurate and low invasive imaging technique to detect DIE of the bowel and compared favorably with clinical evaluation, serum Ca125 determination, and TVS.

Cited by 15 publications

References 27 publications

Optimal imaging modality for detection of rectosigmoid deep endometriosis: systematic review and meta‐analysis

Optimal imaging modality for detection of rectosigmoid deep endometriosis: systematic review and meta‐analysis

Meta-analysis and systematic review to determine the optimal imaging modality for the detection of uterosacral ligaments/torus uterinus, rectovaginal septum and vaginal deep endometriosis

A Prospective Study Comparing Three-Dimensional Rectal Water Contrast Transvaginal Ultrasonography and Computed Tomographic Colonography in the Diagnosis of Rectosigmoid Endometriosis

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