title: Deep infiltrating endometriosis: CT imaging evaluation.
abstract: OBJECTIVE
  To retrospectively evaluate the feasibility of computed tomography (CT) in depicting deep-infiltrating endometriosis.
  
  
  METHODS
  The study population included 54 patients (age: mean, 35.5 years; range, 23-48 years) with histologically confirmed ovarian endometriomas between January 2007 and July 2009. All the patients underwent preoperative CT imaging before laparotomy or laparoscopy. The CT images were evaluated for the presence of a tethered appearance of the rectum in the direction of the uterus, stranding of periuterine pelvic fat, thickening of the uterosacral ligament, and retroflexed uterus. Two radiologists performed a blinded and independent review for each CT finding. The sensitivity, the specificity, the positive predictive value, the negative predictive value, and the accuracy of each CT finding and kappa statistics were determined.
  
  
  RESULTS
  Deep-infiltrating endometriosis was confirmed after surgery and pathologic examination in 34 patients (63.0%). The most specific finding for the diagnosis of deep-infiltrating endometriosis was tethered appearance of rectum in the direction of the uterus (90.0%). The mean sensitivity, specificity, positive predictive value, negative predictive value, and accuracy values of all the CT findings except that of retroflexed uterus were 56.9%, 70.0%, 78.1%, 60.4%, and 61.7%, respectively. The mean kappa value was 0.82 (range, 0.67-0.96).
  
  
  CONCLUSIONS
  Computed tomographic imaging may constitute another potential option as a complementary imaging modality for the evaluation of deep-infiltrating endometriosis.
authors.affiliation: Department of Radiology, Research Institute of Medical Science, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.
authors.forename: Sung Il
authors.initials: SI
authors.lastname: Jung
authors.forename: Young Jun
authors.initials: YJ
authors.lastname: Kim
authors.forename: Hae Jeong
authors.initials: HJ
authors.lastname: Jeon
authors.forename: Kyung-Ah
authors.initials: KA
authors.lastname: Jeong
mesh_terms: D000328:Adult; D004715:Endometriosis / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods