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

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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.

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Acknowledgements

The authors wish to thank Ms. Paulene Butts for preparing the English version of the manuscript, Dr. Domenico Piscitelli, Department of Pathology of the University Hospital “Policlinico” of Bari (Italy) for furnishing figures 1-f and 6-f and Salvatore De Ceglie, radiological technologist, for carrying out MR examinations.

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Authors and Affiliations

  1. Department of Internal Medicine and Public Health (Di.M.I.M.P.)—Section of Diagnostic Imaging, University Hospital “Policlinico”, Piazza Giulio Cesare, 11, 70124, Bari, Italy

    Arnaldo Scardapane, Filomenamila Lorusso, Amato Antonio Stabile Ianora, Maurilia Lasciarrea & Giuseppe Angelelli

  2. Department of General and Specialistic Surgical Sciences, Section of Obstetrics and Gynaecology, University Hospital “Policlinico”, Piazza Giulio Cesare, 11, 70124, Bari, Italy

    Stefano Bettocchi, Antonella Vimercati & Oronzo Ceci

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  1. Arnaldo Scardapane
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  2. Stefano Bettocchi
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Correspondence to Arnaldo Scardapane.

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Scardapane, A., Bettocchi, S., Lorusso, F. et al. Diagnosis of colorectal endometriosis: contribution of contrast enhanced MR-colonography. Eur Radiol 21, 1553–1563 (2011). https://doi.org/10.1007/s00330-011-2079-5

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  • DOI: https://doi.org/10.1007/s00330-011-2079-5

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