Diffusion MRI versus ultrasound in superficial and deep endometriosis

BackgroundEndometriosis is a common and clinically important problem in women of childbearing age. It is classically defined as the presence of functional endometrial glands and stroma outside the uterine cavity and musculature. It may vary from microscopic endometriotic implants to large cysts (endometriomas).ObjectiveTo assess the role of ultrasound and magnetic resonance imaging including diffusion weighted sequences in superficial and deep endometriosis.Patients and methodsThe studied group included 30 patients who were previously clinically diagnosed to have endometriotic lesions between October 2013 and November 2015. These were sent to our department to identify the extent of lesions and clarify the exact location for proper treatment. All patients were evaluated with ultrasound including pelvic and Transvaginal and conventional MRI with diffusion weighted images. The sensitivity, specificity and diagnostic accuracy for both examinations were calculated.ResultsTransabdominal ultrasound examination showed a sensitivity of 81%, specificity of 38% with overall accuracy rate of 73% while transvaginal US showed sensitivity of 88%, specificity of 33% and overall accuracy of 76%. By using conventional MRI the sensitivity showed increase in sensitivity which was 85%, specificity which was 86% and accuracy which was 85%. By the addition of diffusion weighted MRI sensitivity improved to be 97%, specificity 86% and overall accuracy 95%.ConclusionMRI is the most useful technique for determining the extent of endometriosis, especially in the ultrasonographically-indeterminate suspected masses and deep infiltrating lesions as those of the ureters, bladder, and rectosigmoid