Accuracy of transvaginal sonography and contrast-enhanced MR-colonography for the pre-surgical staging of deep infiltrating endometriosis

Objectives: The aim of this study was to investigate the accuracy of transvaginal sonography (TVS) and contrast-enhanced magnetic resonance-colonography (CE-MR-C) for the pre-surgical assessment of deep infiltrating endometriosis (DIE). Methods Ninety women were prospectively enrolled for a suspicion of DIE. All patients underwent a TVS and a CE-MR-C performed blindly, before laparoscopy. The sites of DIE examined by both imaging techniques were: recto-vaginal septum, pouch of Douglas, utero-sacral ligaments, vesico-uterine pouch, bowel, bladder and vagina. The presence of adhesions, the involvement of adnexa and of a previous abdominal scar, in case of a clinical suspicion, were also evaluated. TVS and CE-MR-C findings were compared with laparoscopic and histological results. Results Endometriosis was confirmed by laparoscopy in 95.6% of cases (86//90). In 82.2% (74/90) of patients there was DIE. The global accuracy, sensitivity, specificity, positive predictive values, negative predictive values, positive likelihood ratios and negative likelihood ratios were 89.2%, 81.1%, 94.2%, 89.6%, 89.0%, 13.9 and 0.2 for TVS, 87.2%, 71.1%, 97.1%, 93.7%, 84.6%, 24.4 and 0.3 for CE-MR-C. CE-MR-C allowed to diagnose all cases of bowel involvement; the accuracy for infiltration and stenosis was 100%. The accuracy of TVS for recto-sigmoid nodules and infiltration was 91.1% and 88.9%. Conclusions Both techniques showed satisfactory results. TVS appears a powerful, simple, feasible, cost effective tool for preoperative staging of DIE. CE-MR-C is an "X Ray free" technique, which could be reserved for cases with deep infiltrating rectosigmoid lesions, for the prediction of stenosis and involvement of the upper part of colon and small intestine. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.