Preoperative MRI: A Valuable Tool for Diagnosing Deep Infiltrating Endometriosis

MRI mimicking the surgery findings

Key Points

Highlights:

• Preoperative MRI is a valuable tool in diagnosing deep infiltrating endometriosis (DIE) and the accuracy depends on specific morphological criteria such as lesion size and location.

Importance:

• Accurate diagnosis of DIE is crucial for effective management and treatment and easily applicable tools helping in preoperative time are vital.

What's done here:                       

• To evaluate the diagnostic accuracy of preoperative MRI in detecting DIE based on specific morphological criteria was the aim.
• The study included 160 patients with surgically confirmed DIE who underwent preoperative MRI, and the MRI findings were compared to the surgical findings.
• The surgeries were classified by using the Enzian classification and The MRIs were reported using the deep infiltrating endometriosis morphology score (DEMS).

Key Results:

• Preoperative MRI had a sensitivity of 67.0% and specificity of 84.7% in detecting DIE while accuracy was 75.0%
• The accuracy of MRI in detecting DIE was higher for lesions located in the rectosigmoid colon and uterosacral ligaments.
• The accuracy of MRI in detecting lesions in the bladder and vagina was lower, and the accuracy in distinguishing between active and inactive lesions was limited.

Limitations:

• The study was retrospective and single-center, which may limit its generalizability.
• The study did not evaluate the impact of MRI on patient outcomes or treatment decisions.

Lay Summary

The article by Sebastian Harth et al. is a retrospective study that aimed to evaluate the diagnostic accuracy of preoperative magnetic resonance imaging in detecting deep infiltrating endometriosis based on specific morphological criteria.

The study included 160 patients who underwent preoperative MRI for suspected DIE and subsequently underwent surgery with histological confirmation. The MRI findings were compared to the surgical findings to determine the diagnostic accuracy of the MRI.

The study found that preoperative MRI had a sensitivity of 67.0% and specificity of 84.7% in detecting deep infiltrating endometriosis while accuracy was 75.0%. The diagnostic accuracy of MRI was higher for lesions located in the rectosigmoid colon and uterosacral ligaments.

However, the accuracy of MRI in detecting lesions in the bladder and vagina was lower.

The accuracy of MRI in distinguishing between active and inactive lesions was also limited.

In conclusion, preoperative MRI is a valuable tool in diagnosing deep infiltrating endometriosis, particularly for larger lesions and those located in the rectosigmoid colon and uterosacral ligaments. However, clinicians should be aware of the limitations of MRI in detecting lesions in certain locations and differentiating between active and inactive lesions.

Research Source: https://pubmed.ncbi.nlm.nih.gov/37238278/