Diagnosis of colorectal endometriosis: contribution of contrast enhanced MR-colonography

Eur Radiol. 2011 Jul;21(7):1553-63. doi: 10.1007/s00330-011-2079-5. Epub 2011 Feb 19.

Abstract

Objective: To investigate the contribution of contrast-enhanced MR-colonography (CE-MR-C) for the diagnosis of intestinal endometriosis.

Methods: One hundred and four women with suspected endometriosis were prospectively enrolled. All patients were subjected to MRI consisting of two phases: pelvic high-resolution MRI (HR-MRI) followed by CE-MR-C after colonic distension using a 1.5-liter water enema and injection of 0.15 ml/kg of 0.5 M gadolinium-DTPA with T1w high-resolution isotropic volume (THRIVE) and balanced turbo field echo (BTFE) images. HR-MRI and CE-MR-C were considered as two datasets, which were independently reviewed by two radiologists with 12 and 2 years' experience respectively. The presence of deep pelvic endometriotic lesions with particular attention to colorectal involvement was recorded.

Results: MRI findings correlated with laparoscopy in all cases. Thanks to CE-MR-C images, sensitivity, specificity, PPV, NPV and accuracy for diagnosis of colorectal endometriosis increased from 76%, 96%, 84%, 93% and 91%, to 95%, 97%, 91%, 99% and 97% for the most experienced radiologist and from 62%, 93%, 72%, 89% and 85%, to 86%, 94%, 82%, 96% and 92% for the less experienced radiologist; moreover, the interobserver agreement increased from 0.63 to 0.80 (Cohen's K test).

Conclusion: CE-MR-C allows easier recognition of colorectal endometriosis and higher interobserver agreement.

MeSH terms

  • Adult
  • Colonic Diseases / diagnosis*
  • Colonic Diseases / surgery
  • Contrast Media
  • Endometriosis / diagnosis*
  • Endometriosis / surgery
  • Female
  • Gadolinium DTPA
  • Humans
  • Image Interpretation, Computer-Assisted
  • Laparoscopy
  • Magnetic Resonance Imaging / methods*
  • Predictive Value of Tests
  • Prospective Studies
  • Rectal Diseases / diagnosis*
  • Rectal Diseases / surgery
  • Sensitivity and Specificity

Substances

  • Contrast Media
  • Gadolinium DTPA