Evaluation of colonic involvement in endometriosis: double-contrast barium enema vs. magnetic resonance imaging

Faccioli, Niccolò; Foti, Giovanni; Manfredi, Riccardo; Mainardi, Paride; Spoto, Elide; Ruffo, Giacomo; Minelli, Luca; Mucelli, Roberto Pozzi

doi:10.1007/s00261-009-9544-5

Cited by 56 publications

(44 citation statements)

References 30 publications

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“…On the other hand, in a prospectively enrolled series of 65 women, Faccioli et al [17] reported a lower MRI accuracy for detection of bowel endometriosis (sensitivity 71.1%, specificity 83.3%, PPV 93%, NPV 46.8% and accuracy 74.6%) compared with double-contrast barium enema (sensitivity 84.7%, specificity 93.7%, PPV 98%, NPV 62.5% and accuracy 86.6%). In this study, MRI was performed within 2 h of the enema to take advantage of the residual colon distension without intravenous contrast medium; however, in this protocol, a dedicated distension of the bowel was not performed for MRI and a lower grade of distension might be postulated for the distal colonic loops as most lesions not detected with MRI were located in the sigmoid colon and caecum (5 and 2 lesions respectively).…”

Section: Discussionmentioning

confidence: 94%

“…Transvaginal, transrectal and endoscopic-transrectal ultrasound have demonstrated comparably high degrees of accuracy for predicting intestinal involvement; however, their field of view is limited to the rectum and the possibility to assess the depth of rectal wall involvement is still challenging [9][10][11][12][13][14][15][16]. Recent studies on double-contrast barium enema [10,17,18] emphasize its capabilities in predicting colonic involvement, although the experience required by the radiologist is a limitation for this technique. Multi-slice CT enteroclysis allows estimating the depth of bowel infiltration, but raises the problem of radiation exposure for women in their reproductive years [19,20].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Diagnosis of colorectal endometriosis: contribution of contrast enhanced MR-colonography

Scardapane¹,

Bettocchi²,

Lorusso³

et al. 2011

Eur Radiol

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Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Diagnosis of colorectal endometriosis: contribution of contrast enhanced MR-colonography

Scardapane¹,

Bettocchi²,

Lorusso³

et al. 2011

Eur Radiol

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“…Intestinal involvement in pelvic endometriosis that cause lumen stenosis can be evaluated by DCBE, which performs better than MRI. Its accuracy was reported at nearly 90% (sensitivity 88% and specificity 93%), with a positive predictive value of 97% [64].…”

Section: Double-contrast Barium Enemamentioning

confidence: 99%

“…Double-contrast barium enema (DBCE) has shown promising results when carried out by expert radiologists in the preoperative evaluation of women with clinically suspected intestinal (rectal, sigmoid, cecal) DIE [64]. It does, however, require a low-residue diet for 1 day before the examination, administration of drugs to empty the colon, and exposure to X-rays The presence of DIE is diagnosed on DCBE when the bowel lumen is narrowed at any level from the sigmoid to the anus (extrinsic mass effect) in association with crenulation of the mucosa, spiculation of contour, or both.…”

Section: Double-contrast Barium Enemamentioning

confidence: 99%

Imaging for the evaluation of endometriosis and adenomyosis

Exacoustòs

Manganaro

Zupi

2014

Best Practice & Research Clinical Obstetrics & Gynaecol

211

143

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Endometriosis affects between 5 and 45% of women in reproductive age, is associated with significant morbidity, and constitutes a major public health concern. The correct diagnosis is fundamental in defining the best treatment strategy for endometriosis. Therefore, non-invasive methods are required to obtain accurate diagnoses of the location and extent of endometriotic lesions. Transvaginal sonography and magnetic resonance imaging are used most frequently to identify and characterise lesions in endometriosis. Subjective impression by an experienced sonologist for identifying endometriomas by ultrasound showed a high accuracy. Adhesions can be evaluated by real-time dynamic transvaginal sonography, using the sliding sign technique, to determine whether the uterus and ovaries glide freely over the posterior and anterior organs and tissues. Diagnosis is difficult when ovarian endometriomas are absent and endometriosis causes adhesions and deep infiltrating nodules in the pelvic organs. Magnetic resonance imaging seems to be useful in diagnosing all locations of endometriosis, and its diagnostic accuracy is similar to those obtained using ultrasound. Transvaginal ultrasound has been proposed as first line-line imaging technique because it is well accepted and widely available. The main limitation of ultrasound concerns lesions located above the rectosigmoid junction owing to the limited field-of-view of the transvaginal approach and low accuracy in detecting upper bowel lesions by transabdominal ultrasound. A detailed non-invasive diagnosis of the extension in the pelvis of endometriosis can facilitate the choice of a safe and adequate surgical or medical treatment

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“…Adding water contrast to the rectum during transvaginal ultrasonography may facilitate not only the identification of intestinal endometriotic lesions but also the evaluation of the characteristics of the nodules (size, number, depth of infiltration in the intestinal wall, degree of stenosis of the intestinal lumen) [21][22][23] However, bowel preparation is required before adding water contrast to the rectum. Double-contrast barium enema has been widely used in the past and remains an accurate technique for the diagnosis of bowel endometriosis [24][25][26][27][28][29][30] . Bowel nodules appear as extrinsic masses that are associated with mucosal fine crenulations [26] .…”

Section: Diagnosismentioning

confidence: 99%

Bowel endometriosis: Recent insights and unsolved problems

Ferrero¹

2011

WJGS

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Bowel endometriosis affects between 3.8% and 37% of women with endometriosis. The evaluation of symptoms and clinical examination are inadequate for an accurate diagnosis of intestinal endometriosis. Transvaginal ultrasonography is the first line investigation in patients with suspected bowel endometriosis and allows accurate determination of the presence of the disease. Radiological techniques (such as magnetic resonance imaging and multidetector computerized tomography enteroclysis) are useful for estimating the extent of bowel endometriosis. Hormonal therapies (progestins, gonadotropin releasing hormone analogues and aromatase inhibitors) significantly improve pain and intestinal symptoms in patients with bowel stenosis less than 60% and who do not wish to conceive. However, hormonal therapies may not prevent the progression of bowel endometriosis and, therefore, patients receiving long-term treatment should be periodically monitored. Surgical excision of bowel endometriosis should be offered to symptomatic patients with bowel stenosis greater than 60%. Intestinal endometriotic nodules may be excised by nodulectomy or segmental resection. Both surgical procedures improve pain, intestinal symptoms and fertility. Nodulectomy may be associated with a lower rate of complications.

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Evaluation of colonic involvement in endometriosis: double-contrast barium enema vs. magnetic resonance imaging

Abstract: DCBE is more accurate than unenhanced MRI in the diagnosis of bowel endometriosis, and should be preferred in the preoperative management of this disease, since it usually enables a proper surgical planning.

Cited by 56 publications

References 30 publications

Diagnosis of colorectal endometriosis: contribution of contrast enhanced MR-colonography

Diagnosis of colorectal endometriosis: contribution of contrast enhanced MR-colonography

Imaging for the evaluation of endometriosis and adenomyosis

Bowel endometriosis: Recent insights and unsolved problems

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