Evaluation of the Usefulness of the MRI Jelly Method for Diagnosing Complete Cul-de-Sac Obliteration

Abstract

Objective. We conducted a single-center study to evaluate the usefulness of the magnetic resonance (MR) imaging jelly method for diagnosing endometriosis-associated adhesions in the Pouch of Douglas. Methods. Thirty women with menstrual pain, dyspareunia, and chronic pelvic pain were enrolled in the study. All had been scheduled for laparoscopic surgery on the basis of pelvic and/or ultrasonographic (US) evaluation. All underwent MR imaging both with and without application of US jelly to the vagina and rectum. The images were compared and analyzed postsurgically in a random and blinded fashion by a radiology specialist and a radiology fellow. The radiologists' interpretations of the images were compared to the surgical findings recorded on DVDs. Results. Adhesions in the Pouch of Douglas were found in 21 patients. The sensitivity and specificity of MR imaging without jelly administration were 85.7% and 55.6%, respectively, for the specialist and 81.0% and 55.6%, respectively, for the fellow; with jelly administration, values were 95.2% and 88.9% for the specialist and 90.5% and 66.7% for the fellow. Opacity produced by the jelly increased the sensitivity and specificity for both radiologists. Conclusion. The MRI jelly method is a potentially useful, beneficial, and simple approach for diagnosing Pouch of Douglas adhesions.

Usefulness of T2 star‐weighted imaging in ovarian cysts and tumors

“…However, adhesions around the rectum were difficult to detect by T2*WI, because the bowel gas hindered the T2*WI signal. There have been some recent reports on injecting echo jelly into the rectum and vaginal cavity in order to detect deep endometriosis lesions . Injection of echo jelly into the rectum may diminish rectum air, enabling dense adhesions around the rectum to be evaluated with T2*WI.…”

“…Two radiologists postoperatively diagnosed adhesions by conventional MRI or by adding T2*WI findings. MR findings of adhesions by observing conventional methods were as follows: kissing ovary, ascites in the pouch of Douglas, posterior fornix elevation, intestinal tethering and hyperintensity on T1WI . Figure shows hypointensity on T2*WI observed in suspected adhesions sites outside along the ovarian mass.…”

“…MR findings of adhesions by observing conventional methods were as follows: kissing ovary, ascites in the pouch of Douglas, posterior fornix elevation, intestinal tethering and hyperintensity on T1WI. [11][12][13] Figure 3 shows hypointensity on T2*WI observed in suspected adhesions sites outside along the ovarian mass. The location of the hypointense area on T2*WI corresponded to the adhesion part.…”

Magnetinio Rezonanso Tomografijos Reikšmė Diagnozuojant Endometriozę

“…Tačiau, tiriant pagal įprastinį protokolą, gali kilti sunkumų, nes analizuojama sritis apima keletą raumeninių audinių, turinčių anatominių struktūrų: gimdos-kryžkaulio raiš-čius, makšties, šlapimo pūslę ir tiesiosios žarnos sieneles. Endometriozės židiniai turi panašų MRT signalo intensyvumą kaip ir aplinkiniai audiniai, todėl makšties ir tiesiosios žarnos užpildymas vandens pagrindu pagamintu ultragarso geliu padeda aiškiau apibrėžti anatomines struktūras Duglaso ertmėje [8][9][10]. Ultragarso gelis yra hipointensinis MRT T1W skenavimo sekoje ir hiperintensinis MRT T2W skenavimo sekoje.…”

“…Endometriozė yra viena dažniausių ligų ginekologinėje praktikoje [10], pasireiškianti įvairiais simptomais, yra keletas jos gydymo metodų [11]. Intervencinių diagnostinių ir gydomųjų procedūrų Duglaso ertmėje metu galimas aplinkinių struktūrų pažeidimas [12], todėl būtinas detalus priešoperacinis ligos išplitimo įvertinimas.…”