OC22: Sonovaginography versus nuclear magnetic resonance imaging in the assessment of rectovaginal endometriosis

Abstract

Objectives: Previously we showed that sonovaginography is an accurate ultrasonographic tool in the assessment of rectovaginal endometriosis. The aim of this study was to compare the diagnostic accuracy of sonovaginography and NMR in the diagnosis of recto-vaginal endometriosis. Methods: This was a longitudinal prospective study in which 28 women with rectovaginal endometriosis suspected from the medical history and/or pelvic examination were enrolled. The study group underwent transvaginal ultrasonography and sonovaginography was performed in the same session as follows: an assistant inserted a Foley catheter into the vagina and an ultrasound probe covered with a specific balloon to swell the vagina. The balloon was filled with water (mean 40 mL) and soon after 60-180 mL saline solution was inserted through the Foley catheter to fill the vagina in order to create an acoustic window through the vagina to detect rectovaginal lesions. Within a mean of 30 days after the examination patients were scheduled for pelvic NMR. Once all the diagnostic tests had been performed, patients underwent laparoscopic surgery to enucleate the endometriotic lesion, which was sent for pathological examination. Results: Twenty-three (82.1%) patients had rectovaginal endometri-otic lesions. The sensitivity of sonovaginography was 91.7%, specificity 75%, PPV 95.6% and NPV 60%; the area under the receiver-operating characteristic (ROC) curve was 0.87. In comparison , NMR had a sensitivity of 73.9%, specificity 60%, PPV 89.5% and NPV 33.3%, with an area under the ROC curve of 0.67. The procedure was well tolerated with a median visual analogue scale score of 2 (range, 0-8). Conclusions: Sonovaginography is a well tolerated procedure, with higher accuracy than NMR in the detection of rectovaginal endometriosis. OC23 Magnetic resonance imaging and transvaginal tenderness-guided ultrasonography in diagnosis of the location of deep infiltrating endometriosis Objectives: The aim of our study was to compare the diagnostic accuracy of transvaginal tenderness-guided ultrasonography and pelvic magnetic resonance imaging (MRI) in identification of the location of deep endometriosis implants. Methods: The study was performed in 43 patients suspected who have deep pelvic endometriosis, underwent both MRI and transvaginal tenderness-guided ultrasonography preoperatively. The modified ultrasound approach consists of the use of a larger amount of ultrasound gel in the glove to create a stand-off with better visualization of the vaginal walls and posterior fornix. In addition, the operator evaluated with particular attention the painful sites, as indicated by patients and evoked by a gentle pressure in the specific locations examined: vaginal walls, rectal walls, uterosacral ligaments and anterior compartment (anterior pouch and/or bladder). MRI was carried out using turbo spin-echo (TSE) sequences in T1, T2 and weighted fat-suppressed T1. Results: Deep pelvic endometriosis was present 84% of patients. The sensitivity, specificity, positive and negative p...

Letters to the Editor

“…In some patients, we compared the sensitivity and specificity of this new technique with respect to magnetic resonance imaging (MRI) for diagnosing DIE and concluded that the two techniques are comparable, with the advantage that the former is less expensive and suitable in office setting. 3 Nevertheless, this procedure has some limits. In fact, in our ongoing study we involved 2 physicians skilled in gynecologic sonography, who were trained to perform sonovaginography after the diagnosis was obtained by a skilled operator (E.C.).…”