title: Beyond laparoscopy: 3-T magnetic resonance imaging in the evaluation of posterior cul-de-sac obliteration.
abstract: OBJECTIVE
  Endometriosis is the ectopic localization of endometrial glands. Symptoms include a wide variety of chronic pelvic pain. Ovarian endometriosis represents the most frequent site of implantation followed by the Douglas pouch which is undepicted unless peritoneal fluid is present. Pelvic exams may be reported as normal in 40% of evaluations, although multiple nodularities are located in this region. Nowadays, laparoscopy represents the standard technique for endometriosis evaluation. However, magnetic resonance imaging (MRI) remains the best noninvasive technique for the evaluation of pelvic lesions. According to the importance of a precise preoperative diagnosis of deep infiltrative endometriosis involving the Douglas pouch, we evaluated feasibility of a 3-T system in the evaluation of this particular region.
  
  
  METHODS
  We enrolled 19 women coming with either ultrasound or anamnestic suspicion of endometriosis. Pelvic MRI examination was performed on the 3-T system. We applied a standard exam protocol including pulse sequences [single-shot fast spin echo (FSE)] and high-resolution T2W and T1W FSE sequences with and without FS.
  
  
  RESULTS
  MRI diagnosed posterior cul-de-sac obliteration in 15/19 patients. MRI findings were compared with laparoscopy, thus obtaining the following statistical values: mean sensitivity, specificity, positive predictive value and negative predictive value, respectively, of 93%, 75%, 93% and 75%. Moreover, we calculated an interobserver agreement k value of 0.72 with a substantial degree of agreement between two radiologists of a sensitivity value of 93% and specificity value of 75%.
  
  
  CONCLUSIONS
  Precise preoperative mapping of posterior cul-de-sac region is essential for a preoperative planning. In our work, the 3-T MRI was shown to be excellent in the evaluation of posterior cul-de-sac obliteration associated to an optimal evaluation of the uterosacral ligaments due to the higher contrast spatial resolution.
authors: Department of Radiological Oncological and Anatomopathological Sciences, Umberto I Hospital, Sapienza University of Rome, 00161, Rome, Italy.
authors: Lucia
authors: L
authors: Manganaro
authors: Giorgio
authors: G
authors: Vittori
authors: Valeria
authors: V
authors: Vinci
authors: Francesca
authors: F
authors: Fierro
authors: Alessandra
authors: A
authors: Tomei
authors: Pietro
authors: P
authors: Lodise
authors: Paolo
authors: P
authors: Sollazzo
authors: Maria E
authors: ME
authors: Sergi
authors: Silvia
authors: S
authors: Bernardo
authors: Laura
authors: L
authors: Ballesio
authors: Mario
authors: M
authors: Marini
authors: Maria G
authors: MG
authors: Porpora
mesh_terms: D000328:Adult; D004312:Douglas' Pouch / Q000473:pathology; D004715:Endometriosis / Q000175:diagnosis / Q000473:pathology*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D010535:Laparoscopy / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D015588:Observer Variation; D010053:Ovary / Q000473:pathology*; D011237:Predictive Value of Tests; D011871:Radiology / Q000379:methods; D012680:Sensitivity and Specificity