Endometriosis, the presence of endometrial tissue outside the uterine cavity, affects approximately 10% of women. When surgery is planned for patients with deep infiltrating endometriosis (DIE) – one of three types of clinical presentation – it is essential to define aspects of the intestinal DIE lesions. A radiologist and two gynecological specialists from Brazil explain the importance and relevance of diagnostic imaging in Clinical Medicine Insights: Reproductive Health.
This gynecologic disease is complex due to multifocal patterns of lesion distribution, the presence of extra pelvic sites such as in the urinary and intestinal tracts, and multiple clinical presentations. One of these, deep infiltrating endometriosis (DIE) which manifests itself in the intestine, is defined as a lesion infiltrating at least the muscular layer of the bowel wall. It usually affects the rectum and sigmoid. Surgical intervention is recommended. Ultrasound and/or MRI enable a surgeon to do preoperative mapping, determining the location and the extent of the disease. The preoperative workup helps enable surgeons to determine if conservative (a nodulectomy) or radical surgery should be performed.
Transvaginal ultrasound, transrectal ultrasound, and/or abdominal/pelvic MRI are used to detect ovarian endometrioma, deep endometriosis lesions, and indirect signs of adhesions. In their article, lead author Carlos H. Trippia, MD, of the department of radiology at Roentgen Diagnóstico Institute in Cuntiba, Paraná, and co-authors describe the imaging protocols used.
Morphological characteristics in both MRI and ultrasound include:
For patients with intestinal DIE, the authors recommend that radiology reports contain the following information:
Surgical planning of bowel endometriosis relies on imaging. Appl Radiol.