Posterior Cul-de-Sac Obliteration Associated with Endometriosis: MR Imaging Evaluation

Kataoka, Milliam L.; Togashi, Kaori; Yamaoka, T.; Koyama, Takashi; Ueda, Hiroyuki; Kobayashi, Hisataka; Rahman, Mahbubur; Higuchi, Toshihiro; Fujii, Shingo

doi:10.1148/radiol.2343031366

Cited by 94 publications

(81 citation statements)

References 24 publications

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“…These include angulation of bowel loop, skip of bowel diameter, elevation of the posterior vaginal fornix, posterior displacement of the uterus, ovaries, or both, loss of fat planes between the structures, hidrosalpinx, and loculated fluid collection. Kataoka et al [40] reported a mean sensitivity of 77.8%, a mean specificity of 50.0%, and a mean accuracy of 76.3% for the detection of adhesions.…”

Section: Magnetic Resonance Imaging Evaluationmentioning

confidence: 99%

“…Magnetic resonance imaging MRI can evaluate various signs of involvement of endometriosis in this region: (1) presence of macroscopic endometriosis implants (>5 mm); (2) indirect signs of adhesions, such as disappearance of the fat tissue plane separating the different structures; (3) direct signs of adhesions are well displayed on T2 -weighted imaging as hypointense bands, with variable thickness that result in stretching and distortion of the surrounding organs; (4) uterosacral ligament involvement is suspected in cases of increased and inhomogeneous thickness associated with abnormal arciform appearance; (5) presence of specific signs of posterior cul-de-sac obliteration: retroflexed uterus; tethered appearance of the rectum in direction of the uterus; strands between the uterus and intestine; fibrotic plaque covering the serosal surface of the uterus and elevated posterior cervical fornix [40]; and (6) evaluation of signal intensity of endometriosis lesions is required as it varies according to the microscopic characteristics of the ectopic tissue. Signal intensity can present three main patterns: (1) hypointense signal on both T1-and T2-weighted sequences with hyperintense foci on T2-weighted sequences, which may indicate fibrosis with glandular spots; (2) hypointense signal on T1-weighted and T2-weighted images with hyperintense foci on T1-weighted image, which is caused by haemorrhagic foci within the fibrotic tissue; and (3) hypointense signal in both T1-weighted and T2-weighted sequences if fibrotic reaction is abundant.…”

Section: Deep Infiltrating Endometriosis Of the Posterior-lateral Commentioning

confidence: 99%

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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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Section: Magnetic Resonance Imaging Evaluationmentioning

confidence: 99%

Section: Deep Infiltrating Endometriosis Of the Posterior-lateral Commentioning

confidence: 99%

Imaging for the evaluation of endometriosis and adenomyosis

Exacoustòs

Manganaro

Zupi

2014

Best Practice & Research Clinical Obstetrics & Gynaecol

211

143

View full text Add to dashboard Cite

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“…The presence and location of each endometrial implant were recorded. Endometriotic implants were described as (i) hyperintense nodules on T1-weighted and fat saturated T1-weighted MRI images, irrespective of their appearance on T2-weighted MRI images (13)(14)(15) or (ii) hypointense nodules on both T1-and T2-weighted MRI images with signal intensity close to that of pelvic muscle (12) and Caramella et al (15).…”

Section: Mri Identification Of the Lesionsmentioning

confidence: 99%

MRI and “Tenderness Guided” transvaginal ultrasonography in the diagnosis of recto‐sigmoid endometriosis

Saba

Guerriero

Sulcis

et al. 2011

Magnetic Resonance Imaging

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Purpose: To compare the diagnostic accuracy of MRI and ''tenderness-guided'' transvaginal ultrasonography (tg-TVUS) in the identification of recto-sigmoid endometriosis. Materials and Methods:Institutional Review Board approval for this study was obtained, and written informed consent was given by all patients. This study is compliant with the STARD (Standards for Reporting of Diagnostic Accuracy) method. Fifty-nine patients (mean age, 33 years; range, 21-44 years) with clinical suspicion of deep pelvic endometriosis were prospectively enrolled. They underwent tg-TVUS and MRI before surgery. The characteristics of the MRI signal were analyzed. Mapping of recto-sigmoid endometriosis was performed and tg-TVUS and MR imaging results were compared with surgical and pathological findings. Sensitivity, specificity, and the positive and negative likelihood ratio (LRþ and LRÀ) were calculated. Inter-technique concordance was assessed using the Cohen statistic, and receiver operating characteristic (ROC) curves were obtained. Logistic regression analysis was performed.Results: The prevalence of recto-sigmoid endometriosis was 51%. The specificity, sensitivity, and LRþ and LRÀ were 90%, 73%, 7.089 and 0.297, respectively, for MRI and 86%, 73%, 5.317 and 0.309, respectively, for tg-TVUS. The presence of a high T1 signal spot was an excellent specific finding (100%) but was associated with a low sensitivity (30%). Inter-technique concordance using the Cohen statistic indicated a kappa value of 0.658 (6 0.098 SD). According to the logistic regression equation obtained, the use of both tg-TVUS and MRI allows optimal diagnostic performance.Conclusion: MRI and tg-TVUS show similar results in the identification of recto-sigmoid endometriosis. The Cohen kappa value suggests that these methods may have complementary roles in the identification of recto-sigmoid endometriosis, depending on the site affected.

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“…However, more frequently, a fixed pelvis is caused by a benign disease, either severe endometriosis or severe adhesions with the bilateral tuboovarian complexes adherent to the pelvic sidewalls or from a large fibroid uterus associated with scar tissue or endometriosis [1,2].…”

Section: Introductionmentioning

confidence: 99%

Total laparoscopic extirpation of a fixed uterus from benign gynecological disease

Walid

Heaton²

2010

Gynecol Surg

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Frequently, a fixed pelvis is encountered that is caused by a benign disease, either severe endometriosis or severe adhesions with or without fibroid uterus. We present two cases of nulligravida and multiparous women who had absolute frozen pelvises with no motion whatsoever of their pelvic structures on bimanual examination. Conventionally, these patients would have been approached by open hysterectomy only. We do not consider a frozen pelvis from what appears to be a benign case a contraindication to the laparoscopic approach.

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Posterior Cul-de-Sac Obliteration Associated with Endometriosis: MR Imaging Evaluation

Abstract: These results suggest that use of the described MR imaging findings may enable diagnosis of posterior cul-de-sac obliteration.

Cited by 94 publications

References 24 publications

Imaging for the evaluation of endometriosis and adenomyosis

Imaging for the evaluation of endometriosis and adenomyosis

MRI and “Tenderness Guided” transvaginal ultrasonography in the diagnosis of recto‐sigmoid endometriosis

Total laparoscopic extirpation of a fixed uterus from benign gynecological disease

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