Detection and localization of deep endometriosis by means of MRI and correlation with the ENZIAN score

Paola, Valerio Di; Manfredi, Riccardo; Castelli, Federica; Negrelli, Riccardo; Mehrabi, Sara; Mucelli, Roberto Pozzi

doi:10.1016/j.ejrad.2014.12.017

Cited by 91 publications

(73 citation statements)

References 24 publications

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“…Most MRI studies are performed using at least two orthogonal T2W planes [11, 16–18, 31–33, 44, 45, 54–56]. Further studies are required to clarify the field-of-view used for the axial acquisition and which additional T2W MR plane should be used.…”

Section: Resultsmentioning

confidence: 99%

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European society of urogenital radiology (ESUR) guidelines: MR imaging of pelvic endometriosis

et al. 2016

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Endometriosis is a common gynaecological condition of unknown aetiology that primarily affects women of reproductive age. The accepted first-line imaging modality is pelvic ultrasound. However, magnetic resonance imaging (MRI) is increasingly performed as an additional investigation in complex cases and for surgical planning. There is currently no international consensus regarding patient preparation, MRI protocols or reporting criteria. Our aim was to develop clinical guidelines for MRI evaluation of pelvic endometriosis based on literature evidence and consensus expert opinion. This work was performed by a group of radiologists from the European Society of Urogenital Radiology (ESUR), experts in gynaecological imaging and a gynaecologist expert in methodology. The group discussed indications for MRI, technical requirements, patient preparation, MRI protocols and criteria for the diagnosis of pelvic endometriosis on MRI. The expert panel proposed a final recommendation for each criterion using Oxford Centre for Evidence Based Medicine (OCEBM) 2011 levels of evidence.Key Points• This report provides guidelines for MRI in endometriosis.• Minimal and optimal MRI acquisition protocols are provided.• Recommendations are proposed for patient preparation, best MRI sequences and reporting criteria.Electronic supplementary materialThe online version of this article (doi:10.1007/s00330-016-4673-z) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

“…Magnetic resonance imaging (MRI) is usually performed as an additional examination in complex cases or prior to surgery and is highly accurate in the evaluation of endometriosis [9–18]. However, there is no international consensus on patient preparation, best MRI sequences or reporting criteria.…”

Section: Introductionmentioning

confidence: 99%

European society of urogenital radiology (ESUR) guidelines: MR imaging of pelvic endometriosis

et al. 2016

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“…When the AFS classification is used with the aim of preserving fertility, it is essential to complement it with the ENZIAN classification when treating urinary organs and the bowel. The ENZIAN classification, as assessed by MRI and transvaginal ultrasound , facilitates urethrography and colonoscopy to determine the surgical skills required preoperatively. While medication can be an alternative treatment for endometriosis‐associated pain, DIE progression may cause functional impairment of urinary and gastrointestinal organs and become life‐threatening.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic surgery with urinary tract reconstruction and bowel endometriosis resection for deep infiltrating endometriosis

Ota

Andou

Ota

2018

Asian J Endoscop Surgery

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Deep infiltrating endometriosis (DIE) is the most severe form of endometriosis. It causes chronic pelvic pain, severe dysmenorrhea, deep dyspareunia, dyschezia, and dysuria, markedly impairing the quality of life of women of reproductive age. A number of randomized controlled trials on surgical and medical treatments to reduce the pain associated with endometriosis have been reported, but few have focused on this in DIE. DIE causes not only pain but also functional invasion to the urinary organs and bowel, such as hydronephrosis and bowel stenosis. In addition to DIE resection, surgical treatment involves adhesion separation as well as resection and reconstruction of the urinary organs and bowel; high-level skills are required. The severity of DIE should be evaluated preoperatively as accurately as possible. Using ENZIAN in conjunction with the AFS (The revised American Fertility Society classification of endometriosis) classification makes a more detailed assessment of DIE possible. The operative procedures used for laparoscopic resection of urinary DIE and reconstruction of the urinary organs are chosen based on the type of lesion (intrinsic/extrinsic) and length of stenosis. In addition to ureteroneocystostomy, the psoas bladder hitch and Boari bladder flap procedures are applied when necessary to extend the urinary tract. Bowel resection for bowel endometriosis is classified into classic segmental resection and conservative approaches (shaving/discoid). When these procedures are employed, it is advisable to work in consultation with urologists and gastroenterologists and to inform the patients of the associated risks and outcomes. Furthermore, postoperative medication is essential because it is difficult to conduct repeated surgeries.

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“…Several other methods, such as the Enzian score, [13][14][15][16] ultrasound mapping 17,18 and endometriosis fertility index (EFI) method 19,20 have been proposed as diagnostic methods for endometriosis. The former two diagnostic methods focus on DIE.…”

Section: Introductionmentioning

confidence: 99%

Accuracy and clinical value of an adhesion scoring system: A preoperative diagnostic method using transvaginal ultrasonography for endometriotic adhesion

Ichikawa

Akira

Kaseki

et al. 2020

J of Obstet and Gynaecol

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Aim To investigate the accuracy and clinical value of an adhesion scoring system using transvaginal ultrasonography for endometriotic adhesion. Methods In this prospective observational study, we included 131 patients with endometriosis who underwent surgery. Before surgery, transvaginal ultrasonography and adhesion mapping were performed to determine the presence or absence of adhesions at 10 sites of the pelvis. Mapping accuracy was determined by comparing the mapping findings with the surgical findings. To determine the severity of pelvic adhesions, we developed an adhesion score (0–10). With the adhesion score, we assessed the effect of surgical adhesiolysis and evaluated the relationship between postoperative adhesions and infertility. Results Of the 10 sites assessed for adhesions, the most frequent site of adhesions was the site between the left ovary and the uterus (70.5%). The overall sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio and accuracy of adhesion mapping were 80.4%, 86.1%, 78.8%, 87.2%, 5.79, 0.23 and 83.9%, respectively. The adhesion score in this system was significantly correlated with the adhesion‐related score in the revised American Society for Reproductive Medicine classification (R2 = 0.734). Surgical adhesiolysis yielded only about 30% improvement postoperatively. The adhesion score 1 month after surgery in the non‐in vitro fertilization (IVF) pregnancy group was significantly lower than that in the IVF pregnancy group (3.45 vs 5.21; P = 0.02). Conclusion Our adhesion scoring system allowed an accurate prediction of the pelvic adhesion status and may potentially be an indicator of postoperative adhesions and infertility.

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Detection and localization of deep endometriosis by means of MRI and correlation with the ENZIAN score

Cited by 91 publications

References 24 publications

European society of urogenital radiology (ESUR) guidelines: MR imaging of pelvic endometriosis

European society of urogenital radiology (ESUR) guidelines: MR imaging of pelvic endometriosis

Laparoscopic surgery with urinary tract reconstruction and bowel endometriosis resection for deep infiltrating endometriosis

Accuracy and clinical value of an adhesion scoring system: A preoperative diagnostic method using transvaginal ultrasonography for endometriotic adhesion

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