title: Deeply infiltrating endometriosis: evaluation of retro-cervical space on MRI after vaginal opacification.
abstract: OBJECTIVE
  To prospectively investigate diagnostic value and tolerability of MRI after intra-vaginal gel opacification for diagnosis and preoperative assessment of deeply infiltrating endometriosis.
  
  
  METHODS
  Sixty-three women with clinical suspicion of deeply infiltrating endometriosis were previously examined with trans-vaginal ultrasonography and then with MRI pre and post administration of vaginal gel. We evaluated the tolerability of this procedure with a scoring scale from 0 to 3. We also assessed with a score from 1 to 4 the visibility of four regions: Douglas-pouch, utero-sacral-ligaments, posterior-vaginal-fornix and recto-vaginal-septum. All patients underwent laparoscopic surgery after MRI.
  
  
  RESULTS
  Five patients considered procedure intolerable. Visibility of utero-sacral-ligaments and posterior-vaginal-fornix showed to be increased with gel (p<0.001). In 57 out of 80 patients the MRI has allowed us to diagnose deeply infiltrating endometriosis. Overall, the percentages of MRI-sensitivity, specificity, positive predictive value and negative predictive value were respectively 67.8%, 95.3%, 89.4 and 83.5% without gel, and 90.8%, 94.6%, 90.8% and 94.6% with gel; trans-vaginal ultrasonography sensitivity, specificity, positive predictive value and negative predictive value were 57.5%, 96.6%, 90.9% and 79.5%. In evaluation of utero-sacral-ligaments trans-vaginal ultrasonography, MRI without gel and with gel sensitivity was respectively 61.9%, 47.6% and 81%; for recto-vaginal-septum these values were 12.5%, 68.7% and 93.7%; for pouch of Douglas 82%, 87% and 97.4%; finally for posterior-vaginal-fornix 27.3%, 36.4% and 81.8%.
  
  
  CONCLUSIONS
  MRI with gel opacification of vagina should be recommended for suspicion of deep infiltrating endometriosis, in particular for the added value in evaluation of recto-vaginal septum, utero-sacral ligaments and posterior vaginal fornix.
authors.affiliation: Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiotherapy, Fondazione Policlinico Tor Vergata, Viale Oxford 81, Rome, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Fiaschetti
authors.forename: Sonia
authors.initials: S
authors.lastname: Crusco
authors.forename: Alessandro
authors.initials: A
authors.lastname: Meschini
authors.forename: Valentina
authors.initials: V
authors.lastname: Cama
authors.forename: Livio
authors.initials: L
authors.lastname: Di Vito
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Marziali
authors.forename: Emilio
authors.initials: E
authors.lastname: Piccione
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Calabria
authors.forename: Giovanni
authors.initials: G
authors.lastname: Simonetti
mesh_terms: D000328:Adult; D016477:Artifacts; D004715:Endometriosis / Q000473:pathology*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013382:Subtraction Technique; D014621:Vagina / Q000473:pathology*; D014622:Vaginal Creams, Foams, and Jellies
chemical_list: D014622:Vaginal Creams, Foams, and Jellies