MRI findings predicting the need for colorectal surgical treatment of deep infiltrating endometriosis

Depth and length of bowel lesions on preoperative MRI determine the need for colorectal surgical intervention in patients with deep infiltrating endometriosis.

Key Points

Highlights:

• This study identifies features of deep infiltrating endometriosis on MRI which have an association with colorectal surgical bowel resection.

Importance:

• This study may provide a basis for prospective studies to validate its findings.
• It also may provide additional data for the development of predictive scoring systems to aid surgical planning and resource allocation for the surgical treatment of deep infiltrating endometriosis.

What’s done here?

• Researchers conducted a retrospective cohort analysis to identify MRI features associated with colorectal surgical bowel resection for the treatment of deep infiltrating endometriosis.
• One-hundred twenty-two preoperative pelvic MRIs in women with laparoscopically-proven deep infiltrating endometriosis and subsequent surgery were identified.
• MRIs were reviewed independently by two radiologists blinded to surgical/histopathological outcomes.

Key Points:

• MRI features associated with the colorectal surgical intervention were found to be the presence of an MRI bowel lesion, MRI bowel lesions ≥20 mm in length and MRI bowel lesions invading the muscular or submucosal/mucosal layers.
• Adhesions, the involvement of the torus uterinus, uterosacral ligaments, pouch of Douglas, ovaries and rectovaginal septum; adenomyosis; and the number of bowel lesions were not found to be significantly associated with ‘gold standard’ colorectal surgical resection.

Limitations:

• The cohort size is relatively small.
• Incomplete or poorly recorded clinical data for some patients may have affected results.
• Since the median wait time between the MRI and the time of surgery was long, the disease extends and severity could have changed.

Lay Summary

LAY SUMMARY:

Brusic A. et al., a group of researchers from Australia, conducted a retrospective study to identify the features of deep infiltrating endometriosis on MRI which have an association with colorectal surgical bowel resection. They have recently published their study in the journal named European Journal of Radiology.

One-hundred twenty-two MRIs were included in the analysis. The median age at the time of MRI was 35 years. Of 122 patient MRIs, 71 experienced dyschezia, and 18 patient MRIs experienced haematochezia. Fifteen patients had both symptoms, and 48 patients had neither symptoms. Of 122 patient MRIs, 67 had surgical evidence of bowel involvement with deep infiltrating endometriosis.

Identifying an MRI bowel lesion was found to be more strongly associated with colorectal surgical resection, but was not statistically significant. MRI bowel lesions ≥20 mm in length and bowel lesions invading into at least the muscular layer performed statistically significantly better than current practice which was defined as the recorded presence of a bowel surgeon at the time of surgery.

The researchers found that the presence of an MRI bowel lesion, MRI bowel lesions longer than 20 mm in length and MRI bowel lesions invading the muscular or submucosa/mucosa layers were associated with colorectal surgical intervention.

Adhesions, the involvement of the torus uterus, uterosacral ligaments, pouch of Douglas, ovaries and rectovaginal septum; adenomyosis; and the number of bowel lesions were not found to be significantly associated with ‘gold standard’ colorectal surgical resection.

This retrospective study has several limitations, including the relatively small cohort size and lack of power. The results may have been affected by incomplete or poorly recorded clinical data for some patients. Moreover, the disease extent and severity could have changed because of the long median wait time between the MRI and the time of surgery.

To conclude, this study identifies MRI features that may be useful in identifying the need for colorectal surgical intervention in patients with deep infiltrating endometriosis.

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/31739271