Utility of vaginal and rectal contrast medium in MRI for the detection of deep pelvic endometriosis.
OBJECTIVE
To study the sensitivity of MRI performed utilising vaginal and rectal opacification with ultrasound gel in the detection of deep pelvic endometriosis.


METHODS
This was a prospective monocentric study. All patients evaluated by the gynaecologist for pelvic pain, endometriosis or infertility were included. Axial and sagittal T2-weighted images were performed both with and without vaginal and rectal opacification with ultrasound gel. Three radiologists, all blinded, interpreted the images with a minimum of 15 days between the two readings. MRI performance with and without vaginal and rectal opacification was evaluated by calculating sensitivity, specificity and both positive and negative predictive values.


RESULTS
Seventy-eight patients were included. Among these, 31 patients had deep pelvic endometriosis of which 24 were confirmed by laparoscopy. Seventy-six locations of deep pelvic endometriosis were discovered on MRI. For the three reviewers there was a significant improvement in sensitivity between pre- and post-contrast MRI (p < 0.0002).


CONCLUSIONS
Opacification of the vagina and rectum significantly improved the sensitivity of MRI for the detection of deep pelvic endometriosis by expanding the vagina and rectum, thus allowing better delineation of the pelvic organs. This was especially apparent for lesions localised to the vagina and rectovaginal septum.
Service d'Imagerie diagnostique et interventionnelle, Centre Hospitalier Régional et Universitaire de Nice, Hôpital Archet 2, Nice, France.
M
M
Chassang
S
S
Novellas
C
C
Bloch-Marcotte
J
J
Delotte
O
O
Toullalan
A
A
Bongain
P
P
Chevallier
D000293:Adolescent; D000328:Adult; D003287:Contrast Media; D004715:Endometriosis / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D010388:Pelvis / Q000473:pathology*; D012007:Rectum / Q000473:pathology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014621:Vagina / Q000473:pathology*; D055815:Young Adult
D003287:Contrast Media