title: Diffusion tensor imaging and tractography to evaluate sacral nerve root abnormalities in endometriosis-related pain: a pilot study.
abstract: OBJECTIVE
  To prospectively evaluate microstructural abnormalities in sacral nerve roots in women affected by chronic pelvic pain associated with endometriosis.
  
  
  METHODS
  We enrolled 30 women with an ultrasound diagnosis of endometriosis and moderate-severe chronic pelvic pain; 10 age-matched healthy women comprised the control group. All subjects underwent 3 T magnetic resonance imaging (MRI), including diffusion tensor imaging (DTI); the sacral roots were reconstructed by post-processing the DTI data with dedicated software. Mean fractional anisotropy (FA) values in the S1, S2 and S3 roots were quantified. Analysis of FA values was performed by two radiologists in order to evaluate the interobserver agreement.
  
  
  RESULTS
  The sacral nerve roots in healthy subjects were clearly visualised. Most of the patients with endometriosis displayed abnormalities of S1, S2 and S3 bilaterally at tractography, including an irregular and disorganised appearance. FA values in the S1, S2 and S3 roots were significantly lower in patients than in controls (P < 0.0001, <0.05 and <0.02, respectively) for both observers. No significant difference was found between observers.
  
  
  CONCLUSIONS
  DTI with tractography is a non-invasive means of detecting changes in the microarchitecture of the sacral nerve roots. It can qualitatively and quantitatively reveal sacral root abnormalities in patients with endometriosis-associated pain.
  
  
  CONCLUSIONS
  • MRI is increasingly used for endometriosis and chronic pelvic pain (CPP). • Magnetic resonance tractography can demonstrate microarchitectural abnormalities in sacral nerve roots. • Tractography shows altered microstructure of sacral roots affected by endometriosis and CPP. • S1-S3 fractional anisotropy values are lower in endometriosis than in healthy women. • Sacral nerve root alteration may explain the nature of endometriosis-related CPP.
authors: Department of Radiological Oncological and Anatomopathological Sciences, Umberto I Hospital, "Sapienza" University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
authors: L
authors: L
authors: Manganaro
authors: M G
authors: MG
authors: Porpora
authors: V
authors: V
authors: Vinci
authors: S
authors: S
authors: Bernardo
authors: P
authors: P
authors: Lodise
authors: P
authors: P
authors: Sollazzo
authors: M E
authors: ME
authors: Sergi
authors: M
authors: M
authors: Saldari
authors: G
authors: G
authors: Pace
authors: G
authors: G
authors: Vittori
authors: C
authors: C
authors: Catalano
authors: P
authors: P
authors: Pantano
mesh_terms: D000293:Adolescent; D000328:Adult; D059350:Chronic Pain / Q000175:diagnosis* / Q000209:etiology; D056324:Diffusion Tensor Imaging / Q000379:methods*; D004715:Endometriosis / Q000150:complications / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D010147:Pain Measurement; D017699:Pelvic Pain / Q000175:diagnosis* / Q000209:etiology; D010865:Pilot Projects; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D012447:Sacrum; D013126:Spinal Nerve Roots / Q000473:pathology*; D055815:Young Adult
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