The Role of Magnetic Resonance Imaging in the Planning of Surgical Treatment of Deep Pelvic Endometriosis

Francesco Manti; Caterina Battaglia; Iennarella Bruno; Michele Ammendola; Giuseppe Navarra; Giuseppe Currò; Domenico Laganà

doi:10.3389/fsurg.2022.944399

The Role of Magnetic Resonance Imaging in the Planning of Surgical Treatment of Deep Pelvic Endometriosis

Front Surg. 2022 Jun 28:9:944399. doi: 10.3389/fsurg.2022.944399. eCollection 2022.

Authors

Francesco Manti¹, Caterina Battaglia¹, Iennarella Bruno¹, Michele Ammendola², Giuseppe Navarra³, Giuseppe Currò⁴, Domenico Laganà¹

Affiliations

¹ Radiology Unit, Department of Experimental and Clinical Medicine, "Magna Graecia" University, Catanzaro, Italy.
² Science of Health Department, Digestive Surgery Unit, University "Magna Graecia" Medical School, Catanzaro, Italy.
³ Department of Human Pathology of Adult and Evolutive Age, Surgical Oncology Division, "G. Martino" Hospital, University of Messina, Messina, Italy.
⁴ Science of Health Department, General Surgery Unit, University "Magna Graecia" Medical School, Catanzaro, Italy.

Abstract

Background: To prospectively evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) for the planning of surgical treatment of deep pelvic endometriosis.

Materials and methods: From January 2020 to December 2021, we evaluated 72 patients with symptoms characteristic of endometriosis to plan appropriate surgical treatment. Sensitivity (Se), specificity (Sp), positive and negative predictive values (VPP/VPN), and the accuracy of MRI for the detection of deep pelvic endometriosis were calculated.

Results: Seventy-two patients (mean age, 35.5 years; range, 20-46 years) suspected of having pelvic endometriosis were recruited. Pelvic endometriosis was confirmed at pathologic examination in 56 (77.7%) of 72 patients. A total of 22 (39.3%) of 56 patients were subjected to video laparoscopy (VLS), and 16 (72.2%) of 22 were treated by surgery. Se, Sp, VPP, and VPN in intestinal endometriosis diagnosis were, respectively, 100%, 93.3%, 100%, and 87.5%, and diagnostic accuracy was 95.4%. MRI Se in ureteral endometriosis diagnosis was 50%, Sp 100%, VPP 100%, VPN 78%, and diagnostic accuracy 82%. MRI Se in endometrioma diagnosis was 92.3%, Sp 100%, VPP 100%, VPN 90%, and diagnostic accuracy 95.4%. MRI Se in rectum-vaginal septum (SRV) endometriosis diagnosis was 80%, Sp 100%, VPP 100% VPN 85.7%, and diagnostic accuracy 91%. The MRI Se in the diagnosis of endometriosis involving ULS was 100%, Sp 92.8%, VPP 89%, VPN 100%, and diagnostic accuracy 95.4%. Complete concordance results in a 100% accuracy for all calculated values in diagnosing bladder endometriosis localizations.

Conclusion: MR imaging demonstrates high accuracy in detecting deep pelvic endometriosis in specific locations. It allows the localization of deep pelvic lesions with highly fibrotic components that are hardly recognizable with other imaging methods and not visible with VLS.

Keywords: deep pelvic endometriosis; diagnosis; magnetic resonance imaging; surgical treatment; videolaparoscopic.