MRI for the diagnosis and staging of deeply infiltrating endometriosis: a national survey of BSGE accredited endometriosis centres and review of the literature

Abstract

Objectives: Our objective was to establish the primary mode of imaging and MR protocols utilised in the preoperative staging of deeply infiltrating endometriosis in centres accredited by the British Society of Gynaecological Endoscopy (BSGE). Methods: The lead consultant radiologist in each centre was invited to complete an online survey detailing their protocols. Results Out of 49 centres, 32 (65%) responded to the survey. Two centres performed transvaginal ultrasound as the primary method for preoperative staging of deeply infiltrating endometriosis and the remainder performed MRI. 21/25 centres did not recommend a period of fasting prior to MRI and 22/25 administered hyoscine butylbromide. None of the centres routinely offered bowel preparation or recommended a specific pre-procedure diet. 21/25 centres did not time imaging according to the woman’s menstrual cycle, and instructions regarding bladder filling were varied. Rectal and vaginal opacification methods were infrequently utilised. All centres preferentially performed MRI in the supine position – six used an abdominal strap and four could facilitate prone imaging. Just under half of centres used pelvic-phased array coils and three centres used gadolinium contrast agents routinely. All centres performed T1W with fat-suppression and T2W without fat-suppression sequences. There was significant variation relating to other MR sequences depending on the unit. Conclusions: There was significant inconsistency between centres in terms of MR protocols, patient preparation and the sequences performed. Many practices were out of line with current published evidence. Advances in knowledge: Our survey demonstrates a need for evidence-based standardisation of imaging in BSGE accredited endometriosis centres.

Transvaginal Ultrasound vs. Magnetic Resonance Imaging (MRI) Value in Endometriosis Diagnosis

“…DE lesions are more frequently identified preoperatively by endometriosis specialists with a substantial background in the management and therapy of the condition [ 63 , 64 ]. A gynecologist who has been taught and has expertise with TVS can identify endometriosis lesions more accurately and effectively than a gynecologist who does not generally interpret endometriosis lesions and cannot integrate the imaging interpretations for the correct diagnosis [ 41 ].…”

“…Early identification of DE should be accompanied by a precise assessment of the disease’s severity, which can aid the planning of the surgical intervention [ 64 , 65 ]. Accurate preoperative examinations can help decrease the number of surgeries that are incomplete due to a lack of knowledge of the disease’s width and complexity, as well as direct recommendations to expert centers.…”