Objective: Purpose of this study is to evaluate with magnetic resonance imaging (MRI) precise structures involved in patients with deep infiltrating symptomatic endometriosis for the planning of surgical or conservative treatment. Design: Prospective study. Settings: Villa Claudia Private Clinic (Rome). Patients: Patients suffering from chronic pelvic pain who were referred to the gynecological service in Villa Claudia and underwent MRI between February and May 2018. Interventions: Twenty-five women of reproductive age, suffering from chronic pelvic pain and referring to our gynecological service were enrolled. Firstly, they underwent a gynecological visit, consisting of an accurate physiological and pathological anamnesis followed by a careful objective transvaginal examination, which was particularly aimed at exploring both mobility and pain of the pelvic organs as well as the posterior vaginal arches, in order to research the reason of pain. In twenty of the study women, a diagnosis of Deep Infiltrating Endometriosis was made and, consequently, they underwent MRI as second level diagnostic exam. MRI confirmed the diagnostic suspicion and provided information about the precise localization of endometriosic lesions. Then, all of the twenty women underwent laparoscopy, and all lesions were found and treated. Measurements/Results: Sensitivity, specificity, positive and negative predictive values, and accuracy of MRI diagnosis were evaluated for all the pelvic sites, considering laparoscopic and eventually pathologic findings as the gold standard for diagnosis. Deep infiltrating endometriosis was confirmed at surgery in all patients. The main sites involved were, in order: retrocervical space, rectosigmoid, uterosacral ligaments, tubes, ureters, bladder and vagina. The main signal intensity abnormalities observed were low T2 signal lesions, consisted of fibrosis for the principal components, attracting bowels, ovaries or tubes and suggesting old misdiagnosed lesions. Conclusions: MRI demonstrated high accuracy in diagnosing deep infiltrating endometriosis, distinguishing between nodules, plaques, adhesions or active endometriosis with a 98-100% matching with laparoscopy.
