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      Endometriosis: clinical features, MR imaging findings and pathologic correlation

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          Abstract

          Objective

          We illustrate the magnetic resonance imaging (MRI) features of endometriosis.

          Background

          Endometriosis is a chronic gynaecological condition affecting women of reproductive age and may cause pelvic pain and infertility. It is characterized by the growth of functional ectopic endometrial glands and stroma outside the uterus and includes three different manifestations: ovarian endometriomas, peritoneal implants, deep pelvic endometriosis. The primary locations are in the pelvis; extrapelvic endometriosis may rarely occur. Diagnosis requires a combination of clinical history, invasive and non-invasive techniques. The definitive diagnosis is based on laparoscopy with histological confirmation. Diagnostic imaging is necessary for treatment planning. MRI is as a second-line technique after ultrasound. The MRI appearance of endometriotic lesions is variable and depends on the quantity and age of haemorrhage, the amount of endometrial cells, stroma, smooth muscle proliferation and fibrosis. The purpose of surgery is to achieve complete resection of all endometriotic lesions in the same operation.

          Conclusion

          Owing to the possibility to perform a complete assessment of all pelvic compartments at one time, MRI represents the best imaging technique for preoperative staging of endometriosis, in order to choose the more appropriate surgical approach and to plan a multidisciplinary team work.

          Teaching Points

          • Endometriosis includes ovarian endometriomas, peritoneal implants and deep pelvic endometriosis.

          • MRI is a second-line imaging technique after US.

          • Deep pelvic endometriosis is associated with chronic pelvic pain and infertility.

          • Endometriosis is characterized by considerable diagnostic delay.

          • MRI is the best imaging technique for preoperative staging of endometriosis.

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          Most cited references 52

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          Suggestive evidence that pelvic endometriosis is a progressive disease, whereas deeply infiltrating endometriosis is associated with pelvic pain.

          In a 3-year prospective study of 643 consecutive laparoscopies for infertility, pelvic pain, or infertility and pain, the pelvic area, the depth of infiltration, and the volume of endometriotic lesions were evaluated. The incidence, area, and volume of subtle lesions decreased with age, whereas for typical lesions these parameters and the depth of infiltration increased with age. Deeply infiltrating endometriosis was strongly associated with pelvic pain, women with pain having larger and deeper lesions. Because deep endometriosis has little emphasis in the revised American Fertility Society classification and after analyzing the diagnoses made in each class, considerations for a simplifying revision with inclusion of deep lesions are suggested. In conclusion, suggestive evidence is presented to support the concept that endometriosis is a progressive disorder, and it is demonstrated that deep endometriosis is strongly associated with pelvic pain.
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            Diagnostic accuracy of physical examination, transvaginal sonography, rectal endoscopic sonography, and magnetic resonance imaging to diagnose deep infiltrating endometriosis.

            To compare the value of physical examination, transvaginal sonography (TVS), rectal endoscopic sonography (RES), and magnetic resonance imaging (MRI) for the assessment of different locations of deep infiltrating endometriosis (DIE). Retrospective longitudinal study. Tertiary university gynecology unit. Ninety-two consecutive patients with clinical evidence of pelvic endometriosis. Physical examination, TVS, RES, and MRI, performed preoperatively. Descriptive statistics, calculation of likelihood ratios (LR(+) and LR(-)) of physical examination, TVS, RES, and MRI for DIE in specific locations confirmed by surgery/histology. The sensitivity and LR(+) and LR(-) values of physical examination, TVS, RES, and MRI were, respectively, 73.5%, 3.3, and 0.34, 78.3%, 2.34, and 0.32, 48.2%, 0.86, and 1.16, and 84.4%, 7.59, and 0.18 for uterosacral ligament endometriosis; 50%, 3.88, and 0.57, 46.7%, 9.64, and 0.56, 6.7%, -, and 0.93, and 80%, 5.51, and 0.23 for vaginal endometriosis; and 46%, 1.67, and 0.75, 93.6%, -, and 0.06, 88.9%, 12.89, and 0.12, and 87.3%, 12.66, and 0.14 for intestinal endometriosis. The MRI performs similarly to TVS and RES for the diagnosis of intestinal endometriosis but has higher sensitivity and likelihood ratios for uterosacral ligament and vaginal endometriosis.
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              Anatomical distribution of deeply infiltrating endometriosis: surgical implications and proposition for a classification

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                Author and article information

                Contributors
                0953782360 , pietrofoti@hotmail.com
                Journal
                Insights Imaging
                Insights Imaging
                Insights into Imaging
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                1869-4101
                15 February 2018
                15 February 2018
                April 2018
                : 9
                : 2
                : 149-172
                Affiliations
                [1 ]GRID grid.412844.f, Radiodiagnostic and Radiotherapy Unit, , University Hospital “Policlinico-Vittorio Emanuele”, ; Via Santa Sofia 78, 95123 Catania, Italy
                [2 ]ISNI 0000 0004 1757 1969, GRID grid.8158.4, Department G.F. Ingrassia – Institute of Pathology, , University of Catania, ; Catania, Italy
                [3 ]ISNI 0000 0004 1757 1969, GRID grid.8158.4, Department of General Surgery and Medical-Surgical Specialties – Institute of Obstetrics and Ginecology, , University of Catania, ; Catania, Italy
                Article
                591
                10.1007/s13244-017-0591-0
                5893487
                29450853
                © The Author(s) 2018

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                Categories
                Pictorial Review
                Custom metadata
                © The Author(s) 2018

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