Accuracy of magnetic resonance imaging in diagnosis of deeply infiltrating endometriosis

To determine the accuracy of MRI and diffusion weighted images in the diagnosis of deep infiltrating endometriosis (DIE). This study included 72 patients (mean age, 28years; range, 17–41years). Inclusion criteria were patients who: (a) had a history of symptoms consistent with endometriosis, such as pelvic pain, dysmenorrhea, deep dyspareunia, dyschezia, and infertility; (b) had a pelvic examination revealing thickening of the posterior cul-de-sac and/or nodules; (c) had transvaginal ultrasound showing ovarian cysts with thickened low amplitude echoes. Exclusion criteria were the common contraindications to MRI (pacemaker, metallic foreign bodies, and claustrophobia). MRI was performed using a GE Signa 1.5T MRI system and no contrast medium was used for imaging. In 70/72 patients, DIE was confirmed at surgery and histopathologic examination. 36/72 (50%) patients had endometriotic nodules infiltrating the rectouterine pouch and rectum, 24/72 (33%) the vesicouterine pouch, 6/72 (8.3%) the urinary bladder and 6/72 (8.3%) the anterior abdominal wall. 20/72 patients (27%) had endometrioma correlating with DIE and another 8/72 (11%) had also adenomyosis. In conclusion, preoperative MRI is an excellent tool to provide a reasonably accurate mapping of multiple sites of pelvic endometriosis with high accuracy.