scholarly journals MRI for the diagnosis and staging of deeply infiltrating endometriosis: a national survey of BSGE accredited endometriosis centres and review of the literature

2020 ◽  
Vol 93 (1114) ◽  
pp. 20200690
Author(s):  
Marianne Wild ◽  
Shikha Pandhi ◽  
John Rendle ◽  
Ian Swift ◽  
Emmanuel Ofuasia
Keyword(s):  
Online Survey ◽  
Transvaginal Ultrasound ◽  
Preoperative Staging ◽  
Fat Suppression ◽  
British Society ◽  
Gadolinium Contrast ◽  
Deeply Infiltrating Endometriosis ◽  
Published Evidence ◽  
Gadolinium Contrast Agents ◽  
Infiltrating Endometriosis

Objectives: Our objective was to establish the primary mode of imaging and MR protocols utilised in the preoperative staging of deeply infiltrating endometriosis in centres accredited by the British Society of Gynaecological Endoscopy (BSGE). Methods: The lead consultant radiologist in each centre was invited to complete an online survey detailing their protocols. Results Out of 49 centres, 32 (65%) responded to the survey. Two centres performed transvaginal ultrasound as the primary method for preoperative staging of deeply infiltrating endometriosis and the remainder performed MRI. 21/25 centres did not recommend a period of fasting prior to MRI and 22/25 administered hyoscine butylbromide. None of the centres routinely offered bowel preparation or recommended a specific pre-procedure diet. 21/25 centres did not time imaging according to the woman’s menstrual cycle, and instructions regarding bladder filling were varied. Rectal and vaginal opacification methods were infrequently utilised. All centres preferentially performed MRI in the supine position – six used an abdominal strap and four could facilitate prone imaging. Just under half of centres used pelvic-phased array coils and three centres used gadolinium contrast agents routinely. All centres performed T1W with fat-suppression and T2W without fat-suppression sequences. There was significant variation relating to other MR sequences depending on the unit. Conclusions: There was significant inconsistency between centres in terms of MR protocols, patient preparation and the sequences performed. Many practices were out of line with current published evidence. Advances in knowledge: Our survey demonstrates a need for evidence-based standardisation of imaging in BSGE accredited endometriosis centres.

Transvaginal ultrasound for diagnosis of deeply infiltrating endometriosis

2008 ◽  
Vol 104 (2) ◽  
pp. 156-160 ◽  
Author(s):  
Manoel Orlando Goncalves ◽  
Joao A. Dias ◽  
Sergio Podgaec ◽  
Marcelo Averbach ◽  
Mauricio S Abrão
Keyword(s):  
Transvaginal Ultrasound ◽  
Deeply Infiltrating Endometriosis ◽  
Infiltrating Endometriosis

scholarly journals Clinical Prediction of Deeply Infiltrating Endometriosis before Surgery: Is It Feasible? A Review of the Literature

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Márcia Mendonça Carneiro ◽  
Ivone Dirk de Sousa Filogônio ◽  
Luciana Maria Pyramo Costa ◽  
Ivete de Ávila ◽  
Márcia Cristina França Ferreira
Keyword(s):  
Transvaginal Ultrasound ◽  
Signs And Symptoms ◽  
Reproductive Age ◽  
Therapeutic Interventions ◽  
Deeply Infiltrating Endometriosis ◽  
Anatomical Extent ◽  
Low Sensitivity ◽  
Histological Confirmation ◽  
Specific Symptoms ◽  
Infiltrating Endometriosis

Background. Endometriosis is a chronic benign gynecologic disease that can cause pelvic pain and infertility affecting almost 10% of reproductive-age women. Deeply infiltrating endometriosis (DIE) is a specific entity responsible for painful symptoms which are related to the anatomic location of the lesions. Definitive diagnosis requires surgery, and histological confirmation is advisable. The aim of this paper is to review the current literature regarding the possibility of diagnosing DIE accurately before surgery. Despite its low sensitivity and specificity, vaginal examination and evaluation of specific symptoms should not be completely omitted as a basic diagnostic tool in detecting endometriosis and planning further therapeutic interventions. Recently, transvaginal ultrasound (TVUS) has been reported as an excellent tool to diagnose DIE lesions in different locations (rectovaginal septum, retrocervical and paracervical areas, rectum and sigmoid, and vesical wall) with good accuracy.Conclusion. There are neither sufficiently sensitive and specific signs and symptoms nor diagnostic tests for the clinical diagnosis of DIE, resulting in a great delay between onset of symptoms and diagnosis. Digital examination, in addition to TVS, may help to gain better understanding of the anatomical extent and dimension of DIE which is of crucial importance in defining the best surgical approach.

scholarly journals Medical management of deeply infiltrating endometriosis - 7 year experience in a tertiary endometriosis centre in London

2019 ◽  
Vol 16 (1) ◽  
Author(s):  
Marianne Wild ◽  
Tariq Miskry ◽  
Asmaa Al-Kufaishi ◽  
Gillian Rose ◽  
Mary Crofton
Keyword(s):  
Medical Management ◽  
Obstructive Uropathy ◽  
Intrauterine Device ◽  
Secondary Analysis ◽  
Surgical Excision ◽  
Hormonal Contraceptive ◽  
Reproductive Age ◽  
Deeply Infiltrating Endometriosis ◽  
Hormonal Therapies ◽  
Infiltrating Endometriosis

Abstract Background Deeply infiltrating endometriosis has an estimated prevalence of 1% in women of reproductive age. Ninety percent have rectovaginal lesions but disease may also include the bowel, bladder and ureters. Current practice often favours minimally invasive surgical excision; however, there is increasing evidence that medical management can be as effective as long as obstructive uropathy and bowel stenosis are excluded. Our objective was to establish the proportion of women with deeply infiltrating endometriosis successfully managed with hormonal therapies within our tertiary endometriosis centre in West London. Secondary analysis was performed on anonymised data from the Trust’s endometriosis database. Results One hundred fifty-two women with deeply infiltrating endometriosis were discussed at our endometriosis multidisciplinary meeting between January 2010 and December 2016. Seventy-five percent of women underwent a trial of medical management. Of these, 44.7% did not require any surgical intervention during the study period, and 7.9% were symptomatically content but required interventions to optimise their fertility prospects. Another 7.0% were successfully medically managed for at least 12 months, but ultimately required surgery as their symptoms deteriorated. 26.5% took combined oral contraceptives, 14.7% oral progestogens, 1.5% progestogen implant, 13.2% levonorgestrel intrauterine device, 22.1% gonadotrophin-releasing hormone analogues, and 22.1% had analogues for 3–6 months then stepped down to another hormonal contraceptive. All women who underwent serial imaging demonstrated improvement or stable disease on MRI or ultrasound. Conclusions Medical treatments are generally safe, well tolerated and inexpensive. More than half (52.6%) of women were successfully managed with medical therapy to control their symptoms. This study supports the growing evidence supporting hormonal therapies in the management of deeply infiltrating endometriosis. The findings may be used to counsel women on the likely success rate of medical management.

Elevated Serum and Peritoneal Interleukin-33 Levels in Deeply Infiltrating Endometriosis

2012 ◽  
Vol 19 (6) ◽  
pp. S6-S7
Author(s):  
P. Santulli ◽  
B. Borghese ◽  
S. Chouzenoux ◽  
I. Streuli ◽  
D. de Ziegler ◽  
...  
Keyword(s):  
Elevated Serum ◽  
Interleukin 33 ◽  
Deeply Infiltrating Endometriosis ◽  
Infiltrating Endometriosis
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