Advertisement

European Radiology

, Volume 26, Issue 11, pp 3968–3977 | Cite as

MR diagnosis of diaphragmatic endometriosis

  • Pascal Rousset
  • Jules Gregory
  • Christine Rousset-Jablonski
  • Justine Hugon-Rodin
  • Jean-François Regnard
  • Charles Chapron
  • Joël Coste
  • François Golfier
  • Marie-Pierre Revel
Magnetic Resonance

Abstract

Purpose

To evaluate magnetic resonance imaging (MRI) for diaphragmatic endometriosis diagnosis.

Materials and methods

Over a 2-year period, all diaphragmatic MRI performed in the context of diaphragmatic endometriosis were reviewed. Axial and coronal fat-suppressed T1- and T2-weighted sequences were analyzed by two independent readers for the presence of nodules, plaque lesions, micronodule clustering, or focal liver herniation. MR abnormalities were correlated to surgical findings in women surgically treated. Interobserver agreement was assessed by κ statistics.

Results

Twenty-three women with diaphragmatic endometriosis criteria comprised the population; 14 had surgical confirmation and nine had symptoms relief with hormonal treatment. MRI sensitivity was 83 % (19/23; 95 % confidence interval [CI]: 68, 98) for reader 1 and 78 % (18/23; 95 % CI: 61, 95) for reader 2. Kappa value was 0.86 (95 % CI: 0.47, 1.00). Readers 1 and 2 detected 35 and 36 lesions, respectively, all right-sided and agreed for 32 lesions on the type, location, and signal. Lesions were mostly nodules (23/32, 72 %), predominantly posterior (28/32, 87.5 %) and hyperintense on T1 (20/32, 63 %). MRI was negative for both readers in 2 surgically treated patients with small nodules or isolated diaphragmatic holes.

Conclusion

MRI allows diaphragmatic endometriosis diagnosis with 78 to 83 % sensitivity and excellent interobserver agreement.

Key Points

MRI allows the diagnosis of diaphragmatic endometriosis with up to 83 % sensitivity.

Diaphragmatic endometriosis lesions are better depicted on fat-suppressed T1-weighted sequences.

Diaphragmatic lesions, mostly hyperintense nodules, are right-sided and predominantly posterior.

MRI can help in timely diagnosis of diaphragmatic endometriosis.

Keywords

Endometriosis Magnetic resonance imaging Diaphragm Catamenial pneumothorax Basithoracic pain 

Abbreviations

CT

Computed tomography

MRI

Magnetic resonance imaging

Notes

Acknowledgments

The scientific guarantor of this publication is Pascal Rousset. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Joël Coste, is one of the authors, and is from Biostatistics and Epidemiology department, Groupe Hospitalier Cochin Hôtel-Dieu, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, diagnostic study / observational, multicenter study.

References

  1. 1.
    Olive DL, Schwartz LB (2003) Endometriosis. N Engl J Med 328:1759–1769CrossRefGoogle Scholar
  2. 2.
    Alifano M, Trisolini R, Cancellieri A, Regnard JF (2006) Thoracic endometriosis: current knowledge. Ann Thorac Surg 81:761–769CrossRefPubMedGoogle Scholar
  3. 3.
    Bianconi L, Hummelshoj L, Coccia ME et al (2007) Recognizing endometriosis as a social disease: the european union-encouraged Italian senate approach. Fertil Steril 88:1285–1287CrossRefPubMedGoogle Scholar
  4. 4.
    Joseph J, Sahn SA (1996) Thoracic endometriosis syndrome: new observations from an analysis of 110 cases. Am J Med 100:164–170CrossRefPubMedGoogle Scholar
  5. 5.
    Nezhat C, Seidman DS, Nezhat F, Nezhat C (1998) Laparoscopic surgical management of diaphragmatic endometriosis. Fertil Steril 69:1048–1055CrossRefPubMedGoogle Scholar
  6. 6.
    Redwine DB (2002) Diaphragmatic endometriosis: diagnosis, surgical management, and long-term results of treatment. Fertil Steril 77:288–296CrossRefPubMedGoogle Scholar
  7. 7.
    Ceccaroni M, Roviglione G, Giampaolino P et al (2013) Laparoscopic surgical treatment of diaphragmatic endometriosis: a 7-year single-institution retrospective review. Surg Endosc 27:625–632CrossRefPubMedGoogle Scholar
  8. 8.
    Scioscia M, Bruni F, Ceccaroni M, Steinkasserer M, Stepniewska A, Minelli L (2011) Distribution of endometriotic lesions in endometriosis stage IV supports the menstrual reflux theory and requires specific preoperative assessment and therapy. Acta Obstet Gynecol Scand 90:136–139CrossRefPubMedGoogle Scholar
  9. 9.
    Alifano M, Jablonski C, Kadiri H et al (2007) Catamenial and noncatamenial, endometriosis-related or nonendometriosis-related pneumothorax referred for surgery. Am J Respir Crit Care Med 176:1048–1053CrossRefPubMedGoogle Scholar
  10. 10.
    Rousset-Jablonski C, Alifano M, Plu-Bureau G et al (2011) Catamenial pneumothorax and endometriosis-related pneumothorax: clinical features and risk factors. Hum Reprod 26:2322–2329CrossRefPubMedGoogle Scholar
  11. 11.
    Soriano D, Schonman R, Gat I et al (2012) Thoracic endometriosis syndrome is strongly associated with severe pelvic endometriosis and infertility. J Minim Invasive Gynecol 19:742–748CrossRefPubMedGoogle Scholar
  12. 12.
    Sampson JA (1927) Peritoneal endometriosis due to the menstrual dissemination of endometrial tissue into the peritoneal cavity. Am J Obstet Gynecol 14:422–469CrossRefGoogle Scholar
  13. 13.
    Meyers MA (1973) Distribution of intra-abdominal malignant seeding: dependency on dynamics of flow of ascitic fluid. Am J Roentgenol Radium Ther Nucl Med 119:198–206CrossRefPubMedGoogle Scholar
  14. 14.
    Vercellini P, Abbiati A, Vigano P et al (2007) Asymmetry in distribution of diaphragmatic endometriotic lesions: evidence in favour of the menstrual reflux theory. Hum Reprod 22:2359–2367CrossRefPubMedGoogle Scholar
  15. 15.
    Bricou A, Batt RE, Chapron C (2008) Peritoneal fluid flow influences anatomical distribution of endometriotic lesions: why Sampson seems to be right. Eur J Obstet Gynecol Reprod Biol 138:127–134CrossRefPubMedGoogle Scholar
  16. 16.
    Alifano M, Cancellieri A, Fornelli A, Trisolini R, Boaron M (2004) Endometriosis-related pneumothorax: clinicopathologic observations from a newly diagnosed case. J Thorac Cardiovasc Surg 127:1219–1221CrossRefPubMedGoogle Scholar
  17. 17.
    Jablonski C, Alifano M, Regnard JF, Gompel A (2009) Pneumoperitoneum associated with catamenial pneumothorax in women with thoracic endometriosis. Fertil Steril 91(930):e19–e22PubMedGoogle Scholar
  18. 18.
    Honore GM (1999) Extrapelvic endometriosis. Clin Obstet Gynecol 42(3):699–711CrossRefPubMedGoogle Scholar
  19. 19.
    Arruda MS, Petta CA, Abrao MS, Benetti-Pinto CL (2003) Time elapsed from onset of symptoms to diagnosis of endometriosis in a cohort study of Brazilian women. Hum Reprod 18:756–759CrossRefPubMedGoogle Scholar
  20. 20.
    Freeston JE, Green MJ, King DG, Iveson JM (2006) Chronic shoulder pain and diaphragmatic endometriosis. Rheumatology (Oxford) 45:1533CrossRefGoogle Scholar
  21. 21.
    Posniak HV, Keshavarzian A, Jabamoni R (1990) Diaphragmatic endometriosis: CT and MR findings. Gastrointest Radiol 15:349–351CrossRefPubMedGoogle Scholar
  22. 22.
    Nason LK, Walker CM, McNeeley MF, Burivong W, Fligner CL, Godwin JD (2012) Imaging of the diaphragm: anatomy and function. Radiographics 32:E51–E70CrossRefPubMedGoogle Scholar
  23. 23.
    Bobbio A, Carbognani P, Ampollini L, Rusca M (2007) Diaphragmatic laceration, partial liver herniation and catamenial pneumothorax. Asian Cardiovasc Thorac Ann 15:249–251CrossRefPubMedGoogle Scholar
  24. 24.
    Cohen J (1968) Weighted kappa: nominal scale agreement with provision for scaled disagreement or partial credit. Psychol Bull 70:213–220CrossRefPubMedGoogle Scholar
  25. 25.
    Rousset P, Rousset-Jablonski C, Alifano M, Mansuet-Lupo A, Buy JN, Revel MP (2014) Thoracic endometriosis syndrome: CT and MRI features. Clin Radiol 69:323–330CrossRefPubMedGoogle Scholar
  26. 26.
    Ascher SM, Agrawal R, Bis KG et al (1995) Endometriosis: appearance and detection with conventional and contrast-enhanced fat-suppressed spin-echo techniques. J Magn Reson Imaging 5:251–257CrossRefPubMedGoogle Scholar
  27. 27.
    Bazot M, Gasner A, Lafont C, Ballester M, Darai E (2011) Deep pelvic endometriosis: limited additional diagnostic value of postcontrast in comparison with conventional MR images. Eur J Radiol 80:e331–e339CrossRefPubMedGoogle Scholar
  28. 28.
    Nezhat C, Main J, Paka C, Nezhat A, Beygui RE (2014) Multidisciplinary treatment for thoracic and abdominopelvic endometriosis. Jsls 18(3)Google Scholar
  29. 29.
    Nezhat C, Nicoll LM, Bhagan L et al (2009) Endometriosis of the diaphragm: four cases treated with a combination of laparoscopy and thoracoscopy. J Minim Invasive Gynecol 16:573–580CrossRefPubMedGoogle Scholar
  30. 30.
    Ciriaco P, Negri G, Libretti L et al (2009) Surgical treatment of catamenial pneumothorax: a single centre experience. Interact Cardiovasc Thorac Surg 8:349–352CrossRefPubMedGoogle Scholar
  31. 31.
    Fedele L, Bianchi S, Zanconato G, Berlanda N, Borruto F, Frontino G (2005) Tailoring radicality in demolitive surgery for deeply infiltrating endometriosis. Am J Obstet Gynecol 193:114–117CrossRefPubMedGoogle Scholar
  32. 32.
    Garry R, Clayton R, Hawe J (2000) The effect of endometriosis and its radical laparoscopic excision on quality of life indicators. BJOG 107:44–54CrossRefPubMedGoogle Scholar
  33. 33.
    Sibiude J, Santulli P, Marcellin L, Borghese B, Dousset B, Chapron C (2014) Association of history of surgery for endometriosis with severity of deeply infiltrating endometriosis. Obstet Gynecol 124:709–717CrossRefPubMedGoogle Scholar
  34. 34.
    Kinkel K, Frei KA, Balleyguier C, Chapron C (2006) Diagnosis of endometriosis with imaging: a review. Eur Radiol 16:285–298CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Radiology 2016

Authors and Affiliations

  • Pascal Rousset
    • 1
    • 2
  • Jules Gregory
    • 3
    • 4
  • Christine Rousset-Jablonski
    • 5
  • Justine Hugon-Rodin
    • 3
    • 6
  • Jean-François Regnard
    • 3
    • 7
  • Charles Chapron
    • 3
    • 8
  • Joël Coste
    • 3
    • 4
  • François Golfier
    • 1
    • 5
  • Marie-Pierre Revel
    • 3
    • 9
  1. 1.Lyon 1 Claude Bernard UniversityVilleurbanneFrance
  2. 2.Radiology DepartmentCentre Hospitalier Lyon SudPierre BéniteFrance
  3. 3.Paris Descartes University, Sorbonne Paris CitéParisFrance
  4. 4.Biostatistics and Epidemiology departmentGroupe Hospitalier Cochin Hôtel-DieuParisFrance
  5. 5.Obstetric and Gynecologic DepartmentCentre Hospitalier Lyon SudPierre BéniteFrance
  6. 6.Gynecology Endocrinology DepartmentGroupe Hospitalier Cochin Hôtel-DieuParisFrance
  7. 7.Thoracic Surgery DepartmentGroupe Hospitalier Cochin Hôtel-DieuParisFrance
  8. 8.Obstetric and Gynecologic DepartmentGroupe Hospitalier Cochin Hôtel-DieuParisFrance
  9. 9.Radiology DepartmentGroupe Hospitalier Cochin Hôtel-DieuParisFrance

Personalised recommendations