European Radiology

, Volume 24, Issue 1, pp 95–101 | Cite as

Diffusion tensor imaging and tractography to evaluate sacral nerve root abnormalities in endometriosis-related pain: A pilot study

  • L. Manganaro
  • M. G. Porpora
  • V. Vinci
  • S. Bernardo
  • P. Lodise
  • P. Sollazzo
  • M. E. Sergi
  • M. Saldari
  • G. Pace
  • G. Vittori
  • C. Catalano
  • P. Pantano
Magnetic Resonance
First Online:
Received:
Revised:
Accepted:

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.

Conclusion

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.

Key Points

• 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.

Keywords

Pelvic MRI DTI Tractography Endometriosis Chronic pelvic pain 
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Notes

Acknowledgements

Parts of this article were presented in electronic poster form at ECR 2013: “Fibre tracking evaluation of sacral nervous pathways 3D architecture in women affected by endometriosis”.

References

  1. 1.
    Eskenazi B, Warner ML (1997) Epidemiology of endometriosis. Obstet Gynecol Clin North Am 24:235–258PubMedCrossRefGoogle Scholar
  2. 2.
    Meuleman C, Vandenabeele B, Fieuws S et al (2009) High prevalence of endometriosis in infertile women with normal ovulation and normospermic partners. Fertil Steril 92:68–74PubMedCrossRefGoogle Scholar
  3. 3.
    Ferrero S, Arena E, Morando A et al (2010) Prevalence of newly diagnosed endometriosis in women attending the general practitioner. Int J Gynaecol Obstet 110:203–207PubMedCrossRefGoogle Scholar
  4. 4.
    Fauconnier A, Chapron C, Dubuisson JB et al (2002) Relation between pain symptoms and the anatomic location of deep infiltrating endometriosis. Fertil Steril 78:719–726PubMedCrossRefGoogle Scholar
  5. 5.
    Murphy PG, Ramer MS, Borthwick L et al (1999) Endogenous interleukin-6 contributes to hypersensitivity to cutaneous stimuli and changes in peptides associated with chronic nerve constriction in mice. Eur J Neurosci 11:2243–2253PubMedCrossRefGoogle Scholar
  6. 6.
    Porpora MG, Koninckx PR, Piazze J et al (1999) Correlation between endometriosis and pelvic pain. J Am Assoc Gynecol Laparosc 6:429–434PubMedCrossRefGoogle Scholar
  7. 7.
    Howard FM (2000) Endometriosis and endosalpingiosis. In: Howard FM, Perry CP, Carter JE, El-Minawi AM, Li RZ (eds) Pelvic pain, diagnosis and management. Lippincott Williams & Wilkins, Philadelphia, pp 125–150Google Scholar
  8. 8.
    Solnik MJ (2006) Chronic pelvic pain and endometriosis in adolescents. Curr Opin Obstet Gynecol 18:511–518PubMedCrossRefGoogle Scholar
  9. 9.
    Porpora MG, Pallante D, Ferro A et al (2010) Pain and ovarian endometrioma recurrence after laparoscopic treatment of endometriosis: a long-term prospective study. Fertil Steril 93:716–721PubMedCrossRefGoogle Scholar
  10. 10.
    Stratton P, Berkley KJ (2011) Chronic pelvic pain and endometriosis: translational evidence of the relationship and implications. Hum Reprod Update 17:327–346PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Berkley KJ, Dmitrieva N, Curtis KS et al (2004) Innervation of ectopic endometrium in a rat model of endometriosis. Proc Natl Acad Sci U S A 27:11094–11098CrossRefGoogle Scholar
  12. 12.
    Berkley KJ, Rapkin AJ, Papka RE (2005) The pains of endometriosis. Science 308:1587–1589PubMedCrossRefGoogle Scholar
  13. 13.
    Barena de arellano M, Arnold J et al (2011) Influence of Nerve Growth Factor in Endometriosis-associated Symptoms. Reprod Sciences 18:1202–1210CrossRefGoogle Scholar
  14. 14.
    Tokushige N, Markham R, Russell P, Fraser IS (2006) High density of small nerve fibres in the functional layer of the endometrium in women with endometriosis. Hum Reprod 21:782–787PubMedCrossRefGoogle Scholar
  15. 15.
    Check JH (2011) Chronic pelvic pain syndromes–traditional and novel therapies: part I surgical therapy. Clin Exp Obstet Gynecol 38:10–13PubMedGoogle Scholar
  16. 16.
    Cheong Y, William SR (2006) Chronic pelvic pain: aetiology and therapy. Best Pract Res Clin Obstet Gynaecol Oct 20:695–711CrossRefGoogle Scholar
  17. 17.
    Mori S, Zhang J (2006) Principles of diffusion tensor imaging and its applications to basic neuroscience research. Neuron 51:527–539PubMedCrossRefGoogle Scholar
  18. 18.
    Basser PJ, Pajevic S, Pierpaoli C et al (2000) In vivo fiber tractography using DT-MRI data. Magn Reson Med 44:625–632PubMedCrossRefGoogle Scholar
  19. 19.
    Mori S, van Zijl PC (2002) Fiber tracking: principles and strategies - a technical review. NMR Biomed 15:468–480PubMedCrossRefGoogle Scholar
  20. 20.
    Finley DS, Ellingson BM, Natarajan S et al (2012) Diffusion tensor magnetic resonance tractography of the prostate: Feasibility for mapping periprostatic fibers. Urology 0:219–223CrossRefGoogle Scholar
  21. 21.
    Van der Jagt PK, Dik P, Froeling M et al (2012) Architectural configuration and microstructural properties of the sacral plexus: A diffusion tensor MRI and fiber tractography study. Neuroimage 62:1792–1799PubMedCrossRefGoogle Scholar
  22. 22.
    Takaso M, Aoki Y, Toyone T et al (2011) Quantitative evaluation and visualization of lumbar foraminal nerve root entrapment by using diffusion tensor imaging: preliminary results. AJNR Am J Neuroradiol 32:1824–1829PubMedCrossRefGoogle Scholar
  23. 23.
    Manganaro L, Vittori G, Vinci V et al (2012) Beyond laparoscopy: 3-T magnetic resonance imaging in the evaluation of posterior cul-de-sac obliteration. Magn Reson Imaging 30:1432–1438PubMedCrossRefGoogle Scholar
  24. 24.
    Manganaro L, Fierro F, Tomei A et al (2012) Feasibility of 3.0T pelvic MR imaging in the evaluation of endometriosis. Eur J Radiol 81:1381–1387PubMedCrossRefGoogle Scholar
  25. 25.
    Eguchia Y, Ohtoria S, Oritaa S et al (2011) Quantitative evaluation and visualization of lumbar foraminal nerve root entrapment by using diffusion tensor imaging: Preliminary results. AJNR Am J Neuroradiol 32:1824–1829CrossRefGoogle Scholar
  26. 26.
    Balbi V, Budzik JF, Duhamel A et al (2011) Tractography of lumbar nerve roots: Initial results. Eur Radiol 21:1153–1159PubMedCrossRefGoogle Scholar
  27. 27.
    Martinez B, Canser E, Gredilla E et al (2013) Pain Practice 13:53–58PubMedCrossRefGoogle Scholar
  28. 28.
    Skorpil M, Karlsson M, Nordell A (2012) Peripheral nerve diffusion tensor imaging. Magn Reson Imaging 22:743–745CrossRefGoogle Scholar
  29. 29.
    Meek MF, Stenekes MW, Hoogduin HM et al (2006) In vivo three-dimensional reconstruction of human median nerves by diffusion tensor imaging. Exp Neurol 198:479–482PubMedCrossRefGoogle Scholar
  30. 30.
    Ohana M, Moser T, Meyer N et al (2012) 3T tractography of the median nerve: Optimisation of acquisition parameters and normative diffusion values. Diagn Interv Imaging 93:775–784PubMedCrossRefGoogle Scholar
  31. 31.
    Hogan Q (1996) Size of human lower thoracic and lumbosacral nerve roots. Anesthesiology 85:37–42PubMedCrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2013

Authors and Affiliations

  • L. Manganaro
    • 1
  • M. G. Porpora
    • 2
  • V. Vinci
    • 1
  • S. Bernardo
    • 1
  • P. Lodise
    • 1
  • P. Sollazzo
    • 1
  • M. E. Sergi
    • 1
  • M. Saldari
    • 1
  • G. Pace
    • 3
  • G. Vittori
    • 4
  • C. Catalano
    • 1
  • P. Pantano
    • 3
  1. 1.Department of Radiological Oncological and Anatomopathological SciencesUmberto I Hospital, “Sapienza” University of RomeRomeItaly
  2. 2.Department of Obstetrics and GynecologyUmberto I Hospital, “Sapienza” University of RomeRomeItaly
  3. 3.Department of Neurology and Psychiatry“Sapienza” University of RomeRomeItaly
  4. 4.Division of Obstetrics and GynecologyS. Carlo of Nancy HospitalRomeItaly

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