MRI Best at Detecting Intestinal Deep Infiltrating Endometriosis

Researchers analyzed 159 women who underwent surgery.

Key Points

Highlights:

• Magnetic Resonance Imaging (MRI) seems to be a better method to identify intestinal deep infiltrating endometriosis compared to two-dimensional ultrasonography (2DUS).

Importance:

• This finding could help clinicians decide which diagnostic method to use when deep infiltrating endometriosis is suspected.

Key results:

• 56 out of 66 patients (84.8 percent) were diagnosed with intestinal deep infiltrating endometriosis using 2DUS. This number was 59 out of 66 patients (89.4 percent) with 3DUS and 61 out of 66 patients with MRI (92.4 percent).
• There was no statistically significant difference between the diagnostic methods in identifying deep infiltrating endometriosis in other anatomical areas. 2DUS identified in other anatomic regions as posterior deep infiltrating endometriosis in 55 out of 75 women; while 3DUS detected it in 65 out of 75, and MRI in 66 out of 75 women.
• A total of 12 women had deep infiltrating endometriosis in the anterior location. 2DUS correctly identified this in three of them while 3DUS identified it in five and MRI in six women, which was also not statistically significant. 

Limitations of the study:

• This is a single center study meaning that it may not be possible to generalize the results. 
• The women were operated by different surgeons, which may introduce a bias.
• Imaging results compared to operative surgical findings, where in fact pathology is the gold standard for accurate comparison.

Lay Summary

Magnetic resonance imaging (MRI) seems to be a better method in identifying deep infiltrating endometriosis in the intestine compared to two-dimensional ultrasonography (2DUS), found a study by researchers in Italy and Spain. However, this does not seem to be the case for deep infiltrating endometriosis in other anatomical locations.

“Our results seem to suggest that there is a statistically significant difference between 2DUS and MRI for the intestinal location of deep infiltrating endometriosis,” wrote the authors of the study that was published in the Journal of Ultrasound in Medicine. 

This finding could help guide clinicians in deciding which method to use to diagnose endometriosis and ensuring all areas that are affected are identified.

To identify how accurate two-dimensional and the three-dimensional US are compared to MRI, the team led by Dr. Luca Saba at Azienda Ospedaliero Universitaria di Cagliari in Italy conducted a prospective observational study in 159 women who had surgery because they were suspected of having deep infiltrating endometriosis. None of the women had entered menopause at the time of surgery. 

All women underwent all three diagnosis methods, and doctors looked for the presence of endometriosis in three different areas.

The results showed that 2DUS could identify deep infiltrating endometriosis in the intestine in 56 of 66 patients (84.8 percent), while 3DUS could locate it in 59 patients (89.4 percent) and MRI in 61(92.4 percent) patients. The researchers calculated that there was a statistically significant difference between 2DUS and MRI regarding the ability to identify deep infiltrating endometriosis in the intestine. 

The researchers also identified deep infiltrating endometriosis in other areas using all three methods but this time found that there was no significant difference between the different techniques used and excellent results were obtained using all three methods. 

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/29193230