Skip to main content
SpringerLink
Log in

Multislice CT enteroclysis in the diagnosis of bowel endometriosis

  • Gastrointestinal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

This prospective study aims to evaluate the efficacy of multislice computed tomography combined with colon distension by water enteroclysis (MSCTe) in determining the presence and depth of bowel endometriotic lesions. Ninety-eight women with symptoms suggestive of colorectal endometriosis underwent MSCTe; locations, number of nodule/s, size of the nodule/s and depth of bowel wall infiltration were determined. Independently from the findings of MSCTe, all women underwent laparoscopy. MSCTe findings were compared with surgical and histological results. Abnormal findings suggestive of bowel endometriotic nodules were detected by MSCTe in 75 of the 76 patients with bowel endometriosis. MSCTe identified 110 (94.8%) of the 116 bowel endometriotic nodules removed at surgery; 6 nodules missed at MSCTe were located on the rectum. MSCTe correctly determined the degree of infiltration of the bowel wall in all of the 34 serosal bowel nodules identified at MSCTe. In six nodules reaching the submucosa, the depth of infiltration was underestimated by MSCTe. MSCTe had a sensitivity of 98.7%, a specificity of 100%, a positive predictive value of 100% and a negative predictive value of 95.7% in identifying women with bowel endometriosis. MSCTe is effective in determining the presence and depth of bowel endometriotic lesions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Redwine DB (2004) Intestinal endometriosis. In: Redwine DB (ed) Surgical management of endometriosis. Martin Dunitz, New York, pp 157–171

    Google Scholar 

  2. Remorgida V, Ragni N, Ferrero S, Anserini P, Torelli P, Fulcheri E (2005) The involvement of the interstitial Cajal cells and the enteric nervous system in bowel endometriosis. Hum Reprod 20:264–271

    Article  PubMed  CAS  Google Scholar 

  3. Ferrero S, Abbamonte LH, Remorgida V, Ragni N (2005) Abdominal pain, bloating, and urgency. Obstet Gynecol 106:195

    PubMed  Google Scholar 

  4. Kinkel K, Frei KA, Balleyguier C, Chapron C (2006) Diagnosis of endometriosis with imaging: a review. Eur Radiol 16:285–298

    Article  PubMed  Google Scholar 

  5. Landi S, Barbieri F, Fiaccavento A, Mainardi P, Ruffo G, Selvaggi L, Syed R, Minelli L (2004) Preoperative double-contrast barium enema in patients with suspected intestinal endometriosis. J Am Assoc Gynecol Laparosc 11:223–228

    Article  PubMed  Google Scholar 

  6. Koga K, Osuga Y, Yano T, Momoeda M, Yoshino O, Hirota Y, Kugu K, Nishii O, Tsutsumi O, Taketani Y (2003) Characteristic images of deeply infiltrating rectosigmoid endometriosis on transvaginal and transrectal ultrasonography. Hum Reprod 18:1328–1333

    Article  PubMed  Google Scholar 

  7. Bazot M, Detchev R, Cortez A, Amouyal P, Uzan S, Darai E (2003) Transvaginal sonography and rectal endoscopic sonography for the assessment of pelvic endometriosis: a preliminary comparison. Hum Reprod 18:1686–1692

    Article  PubMed  Google Scholar 

  8. Chapron C, Dumontier I, Dousset B, Fritel X, Tardif D, Roseau G, Chaussade S, Couturier D, Dubuisson JB (1998) Results and role of rectal endoscopic ultrasonography for patients with deep pelvic endometriosis. Hum Reprod 13:2266–2270

    Article  PubMed  CAS  Google Scholar 

  9. Roseau G, Dumontier I, Palazzo L, Chapron C, Dousset B, Chaussade S, Dubuisson JB, Couturier D (2000) Rectosigmoid endometriosis: endoscopic ultrasound features and clinical implications. Endoscopy 32:525–530

    Article  PubMed  CAS  Google Scholar 

  10. Doniec JM, Kahlke V, Peetz F, Schniewind B, Mundhenke C, Lohnert MS, Kremer B (2003) Rectal endometriosis: high sensitivity and specificity of endorectal ultrasound with an impact for the operative management. Dis Colon Rectum 46:1667–1673

    Article  PubMed  Google Scholar 

  11. Chapron C, Vieira M, Chopin N, Balleyguier C, Barakat H, Dumontier I, Roseau G, Fauconnier A, Foulot H, Dousset B (2004) Accuracy of rectal endoscopic ultrasonography and magnetic resonance imaging in the diagnosis of rectal involvement for patients presenting with deeply infiltrating endometriosis. Ultrasound Obstet Gynecol 24:175–179

    Article  PubMed  CAS  Google Scholar 

  12. Thomassin I, Bazot M, Detchev R, Barranger E, Cortez A, Darai E (2004) Symptoms before and after surgical removal of colorectal endometriosis that are assessed by magnetic resonance imaging and rectal endoscopic sonography. Am J Obstet Gynecol 190:1264–1271

    Article  PubMed  Google Scholar 

  13. Bazot M, Darai E, Hourani R, Thomassin I, Cortez A, Uzan S, Buy JN (2004) Deep pelvic endometriosis: MR imaging for diagnosis and prediction of extension of disease. Radiology 232:379–389

    Article  PubMed  Google Scholar 

  14. Bazot M, Darai E (2005) Sonography and MR imaging for the assessment of deep pelvic endometriosis. J Minim Invasive Gynecol 12:178–185

    Article  PubMed  Google Scholar 

  15. Takeuchi H, Kuwatsuru R, Kitade M, Sakurai A, Kikuchi I, Shimanuki H, Kinoshita K (2005) A novel technique using magnetic resonance imaging jelly for evaluation of rectovaginal endometriosis. Fertil Steril 83:442–447

    Article  PubMed  Google Scholar 

  16. Puglielli E, Di Cesare E, Masciocchi C (2004) Rectal endometriosis: MRI study with rectal coil. Eur Radiol 14:2362–2363

    Article  PubMed  Google Scholar 

  17. Darai E, Thomassin I, Barranger E, Detchev R, Cortez A, Houry S, Bazot M (2005) Feasibility and clinical outcome of laparoscopic colorectal resection for endometriosis. Am J Obstet Gynecol 192:394–400

    Article  PubMed  Google Scholar 

  18. Bennett GL, Slywotzky CM, Giovanniello G (2002) Gynecologic causes of acute pelvic pain: spectrum of CT findings. Radiographics 22:785–801

    PubMed  Google Scholar 

  19. Inal M, Bicakci K, Soyupak S, Oguz M, Ozer C, Demirbas O, Akgul E (2000) Hepatic endometrioma: a case report and review of the literature. Eur Radiol 10:431–434

    Article  PubMed  CAS  Google Scholar 

  20. Dwivedi AJ, Agrawal SN, Silva YJ (2002) Abdominal wall endometriomas. Dig Dis Sci 47:456–461

    Article  PubMed  Google Scholar 

  21. Coeman V, Sciot R, Van Breuseghem I (2005) Case report. Rectus abdominis endometriosis: a report of two cases. Br J Radiol 78:68–71

    Article  PubMed  CAS  Google Scholar 

  22. Chung SY, Kim SJ, Kim TH, Ryu WG, Park SJ, Lee DY, Paik HC, Kim HJ, Cho SH, Kim JK, Park KJ, Ryu YH (2005) Computed tomography findings of pathologically confirmed pulmonary parenchymal endometriosis. J Comput Assist Tomogr 29:815–818

    Article  PubMed  Google Scholar 

  23. Fishman EK, Scatarige JC, Saksouk FA, Rosenshein NB, Siegelman SS (1983) Computed tomography of endometriosis. J Comput Assist Tomogr 7:257–264

    Article  PubMed  CAS  Google Scholar 

  24. Rollandi GA, Biscaldi E (2000) CT enema. In: Terrier F, Grossholz M, Becker CD (eds) Spiral CT of the abdomen. Springer, Berlin Heidelberg New York, pp 369–384

    Google Scholar 

  25. Romano S, De Lutio E, Rollandi GA, Romano L, Grassi R, Maglinte DD (2005) Multidetector computed tomography enteroclysis (MDCT-E) with neutral enteral and IV contrast enhancement in tumor detection. Eur Radiol 15:1178–1183

    Article  PubMed  Google Scholar 

  26. Hundt W, Braunschweig R, Reiser M (1999) Evaluation of spiral CT in staging of colon and rectum carcinoma. Eur Radiol 9:78–84

    Article  PubMed  CAS  Google Scholar 

  27. Rotert H, Noldge G, Encke J, Richter GM, Dux M (2003) The value of CT for the diagnosis of acute diverticulitis. Radiologe 43:51–58

    Article  PubMed  CAS  Google Scholar 

  28. Werner A, Diehl SJ, Farag-Soliman M, Duber C (2003) Multi-slice spiral CT in routine diagnosis of suspected acute left-sided colonic diverticulitis: a prospective study of 120 patients. Eur Radiol 13:2596–2603

    Article  PubMed  CAS  Google Scholar 

  29. Schmidt S, Felley C, Meuwly JY, Schnyder P, Denys A (2006) CT enteroclysis: technique and clinical applications. Eur Radiol 16:648–660

    Article  PubMed  Google Scholar 

  30. Thompson WG, Longstreth GF, Drossman DA, Heaton KW, Irvine EJ, Muller-Lissner SA (1999) Functional bowel disorders and functional abdominal pain. Gut 45(Suppl 2):II43–II47

    Article  PubMed  Google Scholar 

  31. Remorgida V, Ragni N, Ferrero S, Anserini P, Torelli P, Fulcheri E (2005) How complete is full thickness disc resection of bowel endometriotic lesions? A prospective surgical and histological study. Hum Reprod 20:2317–2320

    Article  PubMed  CAS  Google Scholar 

  32. Silverman PM, Roberts S, Tefft MC, Brown B, Fox SH, Cooper C, Zeman RK (1995) Helical CT of the liver: clinical application of an automated computer technique, SmartPrep, for obtaining images with optimal contrast enhancement. AJR Am J Roentgenol 165:73–78

    PubMed  CAS  Google Scholar 

  33. Ruess L, Bulas DI, Kushner DC, Silverman PM, Fearon TC (1998) Peak enhancement of the liver in children using power injection and helical CT. AJR Am J Roentgenol 170:677–681

    PubMed  CAS  Google Scholar 

  34. Knight CD, Griffen FD (1980) An improved technique for low anterior resection of the rectum using the EEA stapler. Surgery 88:710–714

    PubMed  CAS  Google Scholar 

  35. Griffen FD, Knight CD (1984) Stapling technique for primary and secondary rectal anastomoses. Surg Clin North Am 64:579–590

    PubMed  CAS  Google Scholar 

  36. Bland M (2000) An introduction to medical statistics, 3rd edn. Oxford University Press, Oxford, UK

    Google Scholar 

  37. Schmidt S, Chevallier P, Chalaron M, Bessoud B, Verdun FR, Frascarolo P, Schnyder P, Denys A (2005) Multidetector CT enteroclysis: comparison of the reading performance for axial and coronal views. Eur Radiol 15:238–246

    Article  PubMed  Google Scholar 

  38. Ruiz-Cruces R, Ruiz F, Perez-Martinez M, Lopez J, Tort Ausina I, De los Rios AD (2000) Patient dose from barium procedures. Br J Radiol 73:752–761

    PubMed  CAS  Google Scholar 

Download references

Author information

Author notes

  1. Ennio Biscaldi

    Present address: , Via Priaruggia 29-20, 16148, Genoa, Italy

Authors and Affiliations

  1. Department of Radiology, “Duchesse of Galliera”-Hospital, Via Mura delle Cappuccine 14, 16128, Genoa, Italy

    Ennio Biscaldi & Gian Andrea Rollandi

  2. Department of Obstetrics and Gynaecology, San Martino Hospital and University of Genoa, Largo R. Benzi X, 16132, Genoa, Italy

    Simone Ferrero, Nicola Ragni & Valentino Remorgida

  3. Di.C.M.I., Unit of Anatomy and Histopathology, San Martino Hospital and University of Genoa, Via De Toni 14, 16132, Genoa, Italy

    Ezio Fulcheri

Authors
  1. Ennio Biscaldi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Simone Ferrero
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ezio Fulcheri
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nicola Ragni
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Valentino Remorgida
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gian Andrea Rollandi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ennio Biscaldi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Biscaldi, E., Ferrero, S., Fulcheri, E. et al. Multislice CT enteroclysis in the diagnosis of bowel endometriosis. Eur Radiol 17, 211–219 (2007). https://doi.org/10.1007/s00330-006-0364-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-006-0364-5

Keywords

Search

Navigation