Magnetic resonance imaging as a non-invasive detection tool for extraovarian endometriosis – own experience

Abstract

Introduction: Endometriosis – due to its high incidence, associated pain and infertility – constitutes an important problem in gynecological practice. The Polish Gynecological Society Expert Panel recommends to perform magnetic resonance imaging (MRI) prior to laparoscopy. The purpose of this study is to present the usefulness of MRI in the diagnosis of extraovarian endometriosis on the basis of own experience. Material and methods: The material consisted of 35 patients, aged 15-52 (mean 36.5 years), who were diagnosed with extraovarian endometriosis on MRI. MR examinations were performed with 1.5 T scanners according to a routine protocol, which incorporates the LAVA sequence of dynamic contrast studies protocol because of thin sections. Results: Extraovarian endometriosis was isolated in 24 patients (68.6%), while in 11 (31.4%) it coexisted with ovarian endometriomas. In 23 cases (65.7%) extraovarian endometriosis was found in one place, in 12 (34.3%) – in two or more locations. Endometriosis was found in the following locations: abdominal wall – 11 cases (31.4%), uterine body – 9 (25.7%), posterior vaginal fornix – 7 (20%), wall of the rectum and sigmoid colon - 5 (14.3% ), pararectal space – 5, uterine cervix – 4 (11.4%), Douglas pouch – 3 (8.6%), Fallopian tube – 2 (5.7%), wall of the small intestine - 1 (2.8%), and urinary bladder – 1. Adhesions were observed in 28.6% of the patients. Conclusions: MRI is an important addition to the non-invasive diagnosis of extraovarian endometriosis and should be performed before treatment, especially surgical one. The inclusion of fat saturated T1 sequence from the dynamic contrast examination in the study protocol increases the likelihood of detecting small endometrial implants.