MRI – advantages and limitations in the diagnosis and treatment of endometriosis

C.L. Vladu, A. Boiangiu, E. Brătilă, R. Vlădăreanu

Rezumat: Endometriosis is a common multifocal gynecologic disease that manifests during the reproductive years, often causing chronic pelvic pain and infertility. It may occur as invasive peritoneal fibrotic nodules and adhesions or as ovarian cysts with hemorrhagic content. Although the findings at the physical examination may be suggestive, imaging is necessary for the definitive diagnosis, patient counseling and treatment planning. The imaging techniques that are most useful for preoperative disease mapping are transvaginal ultrasonography (US) after bowel preparation and magnetic resonance imaging (MRI). Materials and method. In our retrospective study, associations of MRI diagnoses versus intraoperative diagnoses are statistically significant, with high specificity on rectal lesions (96.8%), respectively 96.2% on sigmoid lesions, then parametrial lesions and rectovaginal septum lesions. The dimensions of the rectal nodules had a nonparametric distribution (p<0.05) and the dimensions of the sigmoid nodules had a normal distribution (p>0.05) according to the Shapiro-Wilk test. Despite some limitations, magnetic resonance imaging is able to directly demonstrate deep pelvic endometriosis. The MRI features depend on the type of lesions: infiltrating small implants, solid deep lesions mainly located in the posterior cul-de-sac and involving the uterosacral ligaments and torus uterinus, or visceral endometriosis involving the bladder and rectal wall.
Cuvinte cheie: deep endometriosis, surgical treatment, magnetic resonance imaging.