Lucia Manganaro MD, Abstract Co-Author: Nothing to Disclose

Valeria Vinci MD, Presenter: Nothing to Disclose

Silvia Bernardo MD, Abstract Co-Author: Nothing to Disclose

Paolo Sollazzo, Abstract Co-Author: Nothing to Disclose

Maria Eleonora Sergi MD, Abstract Co-Author: Nothing to Disclose

Matteo Saldari, Abstract Co-Author: Nothing to Disclose

Carlo Catalano MD, Abstract Co-Author: Nothing to Disclose

Feasibility of contrast enhanced (CE) MRI with rectal filling to differentiate between recto-sigmoid DIE and silent fibrotic adhesions, and to assess the severity of infiltration.

From October 2011 and April 2013 We enrolled 18 women coming with either ultrasound or clinical suspect of posterior endometriosis. We performed a pelvic MRI examination on 1,5T system, with intravenous administration of gadobenate dimeglumine (Gd-BOPTA) and rectal filling with ultrasonoghraphic gel. We evaluated the presence of recto-sigmoid involvements and its nature by taking in consideration the different CE behaviour.All patients underwent to laparoscopy within 1 month from MRI.

MRI diagnosed posterior cul-de-sac obliteration in 15/18 patients. 5/15 cases MRI reported fibrotic strand between uterus and rectum. In other 6/15 cases, MRI detected wide nodules (mean diameter 18mm) on the Rectal surface, involving at full depth the muscolaris mucosa, these nodules were easily visible thanks to the difference of CE between the lesion and the normal enhancing surrounding muscolaris mucosa. In all cases overlying mucosa was intact.In4/15 cases MRI detected smaller implants on the rectal wall, (mean diameter 8 mm); 3/4 appeared to involve partially the rectal wall, thus were suggestive for DIE; on the contrary 1/3 showed to be clearly remarkable from rectal wall in CE phase, therefore we suggested to be a pseudo-nodular adhesion.MRI findings were compared to laparoscopy, which demonstrated that the small implants suggestive for pseudo-nodular adhesion was indeed a implants of DIE (False negative); 1case of small implants reported as DIE on MRI revealed to be fibrotic adhesion (False positive).We achieved a 92%sensitivity and a 75%specificity.  

This study shows that CE MRI and rectal filling are suitable for the diagnosis of recto-sigmoid endometriosis and mainly in differentiating between fibrotic adhesions and DIE. Moreover, CE MRI may allow to detect the severity of infiltration trough rectal wall. All these information are important to guide the surgeon towards a resection or shaving of the nodules of DIE, or for the lysis of the adesions.

CE MRI associated to rectal filling proved to be suitable to differentiate between adhesions and DIE ;differentiate between these two type of manifestation is crucial for the surgical planning.

Manganaro, L, Vinci, V, Bernardo, S, Sollazzo, P, Sergi, M, Saldari, M, Catalano, C, Endometriosis: Is there a Way to Differentiate between Silent Fibrotic Adhesions and DIE with MRI?.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13028329.html