Keywords:
Genitourinary, Colon, Contrast agents, Genital / Reproductive system female, MR, Contrast agent-other, Health policy and practice, Outcomes analysis, Outcomes, Retrospective, Diagnostic or prognostic study, Performed at one institution
Authors:
R.-E. Chung1, S. LEE2, A. Stankiewicz1, J. ritchie1; 1Stoke-on-Trent/UK, 2Stoke on Trent/UK
DOI:
10.26044/ecr2020/C-10859
Conclusion
While laparoscopic remains the gold standard in identifying the location of these lesions, there is renewed interest in MRI in providing concise preoperative imaging in particular in identifying deep infiltrative pelvic endometriosis in order to optimize the appropriate surgical technique to maximise chances of a good outcome, with early detection and involvement of specialist colorectal team in its pre-operative planning. This in turn has likely led to a significant time between MRI imaging to time of surgery. While this could be thought to cause further progression of endometriosis, our analysis of the cases of “misses” has not shown a correlation between developing interval infiltrative disease with time.
Local guidelines are proven to be consistent with the ESUR guidelines which provide satisfactory accuracy and specificity of MRIs in identifying invasive colorectal endometriosis and consistent with other studies3, therefore rectal contrast is deemed unnecessary for future practice on the balance of patient acceptability and sensitivity.
MRI remains the main modality in our centre for pre-operative assessment and surgical planning in patients with suspected infiltrative endometriosis. While various studies have shown that Ultrasound is comparable in both specificity and sensitivity, MRI is considered less invasive and not operator dependant albeit more costly, and can be reported remotely by an expert raising accuracy. More importantly MRI is considered more advantageous in assessing deep sited endometriosis due to its multiplanar capabilities and ability to differentiate normal and diseased tissue to assess depth of involvement.