Defining probabilities of bowel resection in deep endometriosis of the rectum: <scp>P</scp>rediction with preoperative magnetic resonance imaging

Perandini, Alessio; Perandini, Simone; Montemezzi, Stefania; Bonin, Cecilia; Bellini, Gaia; Bergamini, Valentino

doi:10.1111/jog.13523

Cited by 8 publications

(3 citation statements)

References 11 publications

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“…A recent publication 45 shows an interesting algorithm that allows clinicians to predict the probability of bowel resection at the time of laparoscopy for DIE using MRI. In 52 patients studied preoperatively, a positive predictive value of 87% and a negative predictive value of 83% were demonstrated.…”

Section: Diagnosismentioning

confidence: 99%

Endometriosis: advances and controversies in classification, pathogenesis, diagnosis, and treatment

2019

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Endometriosis is an enigmatic disease that could start at birth. Its pathogenesis is supported by different theories. Accumulating facts relate it to a multigenic disorder. In this review of recent publications, the principal symptoms of the disease, pain and infertility, as well as its pathogenesis, diagnosis, and classification will be addressed. Endometriosis presents three main variants: superficial peritoneal disease, deep infiltrating endometriosis, and ovarian endometriomas. The management of the disease, surgery, and medical and alternative therapies will be discussed. Special reference will be made to the quality of surgery and how to understand patients with endometriosis and endometriosis.

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Section: Diagnosismentioning

confidence: 99%

Endometriosis: advances and controversies in classification, pathogenesis, diagnosis, and treatment

2019

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“…In the current study, bowel resection was performed in 22% of all patients, clearly more often in patients with the cloverleaf sign on a preoperative MRI (41% vs 13%). Perandini et al 9 defined a method to predict the probability of rectum resection before DIE surgery. The method was based on measuring the largest diameter of the rectum DIE and the impact angle on the MRI (n = 52).…”

Section: Discussionmentioning

confidence: 99%

“…However, it is estimated that, in 80% of cases, the decision to do bowel resection is made during the surgery; this makes the planning of the surgery more difficult for multidisciplinary surgeon team and also the more complex intervention, which requires obtaining more comprehensive informed consent from the patient, just in case. 9 There is currently no method to predict whether conservative surgery is feasible or whether bowel resection is required. Therefore, precise diagnosis is essential in order to allow the surgeon to obtain the appropriate preoperative informed consent and to organize the multidisciplinary surgical team that is required.…”

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confidence: 99%

Cloverleaf Sign in Pelvic Magnetic Resonance Imaging for Deep Infiltrating Endometriosis

Härmä¹,

Binda²,

Ith³

et al. 2019

Invest Radiol

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The aim of this study was to evaluate the significance of a new imaging sign, the "cloverleaf sign," in diagnosing deep infiltrating endometriosis (DIE) with magnetic resonance imaging (MRI) in concordance to intraoperative findings. Materials and Methods: This retrospective study included 103 patients operated during the January 2016 to June 2018 period with preoperative 1.5 T and 3 T MRI, with or without vaginal and rectal gel filling. Magnetic resonance imaging scans were read blinded to intraoperative findings by a specialized gynecologic radiologist and a junior radiologist, and then compared with intraoperative findings by looking at the operation report, postoperative diagnosis, and intraoperative images and videos by an experienced gynecologist surgeon specialized in endometriosis surgery. All endometriosis lesions were confirmed by pathology. The "cloverleaf sign" was defined as a cloverleaf-like figure in imaging morphology; the "leaves" formed by at least 3 different organs come together in the center of the figure formed by constrictive adhesions including T2-weighted (T2W) hypointense DIE. Operation times, intraoperative blood loss, and the frequency of DIE and bowel resections were analyzed in cloverleaf and noncloverleaf groups. The 2-sample Wilcoxon rank-sum (Mann-Whitney U) test and multivariate analysis of variance were used to calculate the significance of an overall impact of cloverleaf sign on operation time, blood loss, and the amount of the bowel resection rate. P < 0.05 was considered statistically significant. Results: The prevalence of DIE in the study population was 79.6%. A total of 11.5% of the patients had no endometriosis, 32.6% had rASRM I and II, and 55.9% had rASRM III and IV. Forty-six patients (45%) had received rectal and vaginal gel opacification before scanning, 57 (55%) did not. A cloverleaf sign on MRI was detected in 34 patients (15 in gel filling and 19 in nonfilling group). The interreader agreement was almost perfect 0.91 (κ). The median operation time in the cloverleaf group was 248 minutes (interquartile range [IQR], 165-330) compared with 145 minutes in the noncloverleaf group (IQR, 90-210), that is, significantly higher (P < 0.001). Intraoperative blood loss was also significantly higher in the conglomerate group (125 vs 50 mL; IQR, 100-300 vs 50-100; P < 0.001). Of the bowel resections in our study population, 41% (14/34) were performed on patients with a cloverleaf sign in the MRI, compared with 13% (9/69) in patients without the cloverleaf sign. Conclusions: The "cloverleaf " MRI sign was associated with significantly longer operation time, increased intraoperative blood loss, and higher rates of bowel resection in DIE patients.

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Rectal endometriosis: predictive MRI signs for segmental bowel resection

et al. 2020

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Defining probabilities of bowel resection in deep endometriosis of the rectum: Prediction with preoperative magnetic resonance imaging

Abstract: MRI could be of value in predicting the need for bowel resection in deep endometriosis of the rectum. Further research is required to assess the possibility of a wider application of this algorithm outside our single-center study.

Cited by 8 publications

References 11 publications

Endometriosis: advances and controversies in classification, pathogenesis, diagnosis, and treatment

Endometriosis: advances and controversies in classification, pathogenesis, diagnosis, and treatment

Cloverleaf Sign in Pelvic Magnetic Resonance Imaging for Deep Infiltrating Endometriosis

Rectal endometriosis: predictive MRI signs for segmental bowel resection

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