Can diffusion and T2 star-weighted magnetic resonance imaging aid in the diagnosis of ectopic endometrium?

Abstract

Background Endometriosis is a common gynecologic disorder characterized by the implantation of the endometrial tissue ectopically outside the endometrial cavity. It affects about 10% of females at the childbearing period and is estimated to be present up to 20–50% in women complaining of infertility. While laparoscopy is considered the mainstay for diagnosis, magnetic resonance imaging (MRI) is recognized as a useful tool for definitive diagnosis, pre-surgical planning, and determining whether the patient will require multi-specialty involvement. The aim of this study is to evaluate the performance of MRI with the addition of diffusion-weighted imaging (DWI) and T2 star (T2*) to conventional MRI, for the accurate assessment of ectopic endometrium. Results Endometriotic lesions that showed diffusion restriction on DWI were 80.7%, and 96.1% of the endometriotic lesions had signal voids on the T2*W sequence, whereas only 65.4% of the lesions had typical signal intensities on T1WI and T2WI. Diagnostic performance of the MRI examination was improved by the use of the diffusion sequence and better improved by the T2* sequence, compared to the conventional MR protocol sensitivity (SE) = 96.12% and specificity (SP) = 85.7% in T2*-weighted images, SE = 80.7% and SP = 71.4% in DWI, and SE = 65.4% and SP = 71.4% in conventional MRI. P value for conventional MRI was 0.1, which is of no statistical significance (p < 0.05). P value for DWI was 0.016, which is statistically significant (p < 0.05). P value for T2*WI was 0.001, which is more statistically significant (p < 0.05) and could be adequately correlated with laparoscopy. Conclusion DWI and T2* significantly increase MRI diagnostic accuracy by allowing the detection of the hemorrhagic character of the endometriotic lesions. Studies with a large sample size are needed to confirm that they can replace invasive laparoscopy for the diagnosis of endometriosis.

T2*-Weighted Imaging Performance in the Detection of Deep Endometriosis among Readers with Different Experience: Comparison with Conventional MRI Sequences

“…For this reason, it has recently been proposed in the literature that T2*W imaging can provide added diagnostic value to conventional MRI protocols in endometriosis detection [ 13 , 14 ]. Some authors suggested that susceptibility-weighted imaging (SWI) can contribute to the diagnosis of endometriomas by revealing T2*W signal voids in the cyst wall [ 18 , 19 ].…”

“…Pin et al found that susceptibility-weighted sequences might improve the diagnostic performance of conventional MRI protocol in DIE assessment, with an increase in sensitivity (from 88.2% to 94.1%) and specificity (from 68.8% to 73.3%) [ 22 ]. In a recent publication, the addition of T2*W sequences to MRI protocols revealed even more favourable results: the sensitivity improved from 65.4% to 96.15%, while the specificity improved from 71.4% to 85.7% [ 14 ]. Nevertheless, in this study both readers were highly experienced radiologists, which may represent a limitation to the generalizability of the results.…”

“…A number of publications have recently suggested that T2*W and susceptibility-weighted MRI can provide added value to detecting ectopic endometrium by identifying haemosiderin deposited during cyclic bleeding [ 13 , 14 ]. Nevertheless, these sequences are currently not included in conventional protocols suggested by international guidelines and are still considered under evaluation or optional [ 10 , 15 ].…”

Diagnostic Value and Clinical Application of Diffusion‐Weighted Magnetic Resonance Imaging for Female Pelvic Lesions

“…When the elasticity of the pelvic floor muscles becomes poor, the internal organs of the pelvic floor cannot maintain their normal positions, and the corresponding functions are impaired [ 17 ]. It is the only way to display the trajectory of muscle fiber bundles in vivo through the principle of anisotropy in the diffusion movement of water molecules in tissues [ 18 ] because the microstructure of tissue specimens will inevitably change during the processing process, resulting in geometric deformation. DTI adopts the cross-sectional spin echo-echo planar imaging (SE-EPI) technology, in which there are many parameters, and the most used are the diffusion sensitivity coefficient (b), the eigenvalues ( λ 1 , λ 2 , λ 3 ), average dispersion rate, fractional anisotropy, and apparent diffusion coefficient [ 19 ].…”

Diagnostic Accuracy of Diffusion Weighted Magnetic Resonance in Differentiating Between Malignant and Benign Endometrial Soft-Tissue Lesions

“…MRI is more sensitive in diagnosis of origin, composition, shape, and lesion enhanced pattern specify the diagnosis differences [8]. Diffusion-weighted (DW) MRI is based on water molecules random movement within different tissues [9]. MRI has high tissue contrast and can be used to evaluate peritoneal deposits, metastatic lesions, tumour recurrence, and treatment response when combined with apparent diffusion coefficient (ADC) mapping [10].…”