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Mhezi V, Nkrumbih Z, Majura M. An Atypical Case of Thoracic Endometriosis Syndrome Mimicking Pulmonary Tuberculosis. Case Rep Radiol 2025; 2025:1708094. [PMID: 40433355 PMCID: PMC12116124 DOI: 10.1155/crra/1708094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2024] [Accepted: 04/23/2025] [Indexed: 05/29/2025] Open
Abstract
Background: Thoracic endometriosis syndrome (TES) is a rare form of endometriosis characterized by the presence of functioning endometrial tissue in the thoracic cavity. Patients are women of reproductive age, with a genetic link as a significant risk factor. Patients present with long-standing chest symptoms and signs that mimic pulmonary tuberculosis (PTB). The crucial issue for establishing the diagnosis is the cyclicity of signs and symptoms which occur along with the menstrual cycle. Clinical Case: A 34-year-old businesswoman had recurrent pelvic pain and heavy menses for 6 years, recurrent chest pain for 5 years, and recently coughing blood for 3 days. Symptoms peaked during menstruation. She reported a maternal grandmother with similar symptomatology. For the past 6 years, she was treated for recurrent pneumonia and PTB without improvement. Examination revealed right-sided pleural effusion and generalized pelvic tenderness. The catamenial nature of her symptoms led to a suspicion of TES, with PTB. Pleural fluid analysis showed exudative effusion, and Gene X-pert for MTB was negative. CA-125 was elevated, a nonspecific endometriosis marker. Pelvic ultrasound revealed features of pelvic endometriomas. Serial chest X-ray and CT scan showed right hydropneumothorax, lung mass, lung collapse, and pulmonary fibrosis. Multiple chest tubes were placed for the recurrent hydropneumothorax management. Exploratory laparotomy with bilateral ovarian cystectomy was done, and histology revealed ovarian hemorrhagic cysts and salpingitis. Hormonal suppression initiated as mainstay of treatment. She is monitored monthly as an outpatient to assess treatment efficacy and condition progression. Conclusion/Learning Points: TES is a form of endometriosis involving the thoracic cavity, affecting women of reproductive age. TES may mimic PTB but symptoms correlate with the menstrual cycle (catamenial in nature). In Tanzania, diagnostic challenges persist due to its nonspecific symptoms, inadequate clinicians' awareness, and lack of treatment guideline national wide.
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Affiliation(s)
- Victor Mhezi
- Department of Radiology and Imaging, Songea Regional Referral Hospital, Songea, Ruvuma, Tanzania
- Department of Radiology and Imaging, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Zuhura Nkrumbih
- Department of Radiology and Imaging, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Magafu Majura
- Department of Obstetrics and Gynecology, Songea Regional Referral Hospital, Songea, Ruvuma, Tanzania
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Zulfiqar M, Brown PJ, Chughtai K, Navale P, Tan N, Yano M, Aamir A, Van Tassel D, Siegel CL, Kawashima A. Imaging of the Urachus. Radiographics 2025; 45:e240122. [PMID: 40208809 DOI: 10.1148/rg.240122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2025]
Abstract
The urachus is a remnant fibrous cord of the allantois and the ventral aspect of the cloaca that connects the urinary bladder to the anterior abdominal wall at the level of the umbilicus. The authors explore the embryologic origins of the urachus and delineate its normal anatomy, followed by a discussion of urachal pathologic conditions seen with different imaging modalities-including US, CT, and MRI-using a case-based approach. Although it is a vestigial structure, the urachus can harbor significant disease, including congenital anomalies arising secondary to varying degrees of incomplete involution of the urachus and ranging from focal patency (urachal cyst, diverticulum, and sinus) to complete patency (patent urachus). The spectrum of congenital abnormalities can manifest with various clinical findings and is often discovered at imaging when infected. Understanding the embryogenesis of the urachus is therefore crucial for understanding the imaging manifestations of urachal abnormalities. Nonneoplastic urachal masses can be inflammatory and sometimes difficult to differentiate from malignancy. In women, the urachus can be involved by endometriosis. Neoplastic urachal entities can include mucinous cystadenoma, which can rupture with associated mucinous ascites. Adenocarcinoma is the most common urachal malignancy and frequently can extend to involve the urinary bladder. Other malignant urachal entities include urothelial carcinoma and metastasis. Mimics of urachal pathologic conditions can cause diagnostic misperception and include primary bladder malignancy, infections, and dropped gallstones or appendicoliths. This comprehensive overview aims to enhance radiologists' proficiency in recognizing and interpreting urachal abnormalities, thus contributing to improved patient outcomes. ©RSNA, 2025 Supplemental material is available for this article.
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Affiliation(s)
- Maria Zulfiqar
- From the Department of Radiology, Mayo Clinic Arizona, 13400 E Shea Blvd, Scottsdale, AZ 85259 (M.Z., P.J.B., N.T., M.Y., D.V.T., A.K.); Department of Radiology, Weill Cornell Medicine, New York, NY (K.C.); Department of Pathology (P.N.) and Mallinckrodt Institute of Radiology (C.L.S.), Washington University School of Medicine in St Louis, St Louis, Mo; and Department of Radiology, Phoenix Children's Hospital (A.A., D.V.T.) and University of Arizona (A.A.), Phoenix, Ariz
| | - Parker J Brown
- From the Department of Radiology, Mayo Clinic Arizona, 13400 E Shea Blvd, Scottsdale, AZ 85259 (M.Z., P.J.B., N.T., M.Y., D.V.T., A.K.); Department of Radiology, Weill Cornell Medicine, New York, NY (K.C.); Department of Pathology (P.N.) and Mallinckrodt Institute of Radiology (C.L.S.), Washington University School of Medicine in St Louis, St Louis, Mo; and Department of Radiology, Phoenix Children's Hospital (A.A., D.V.T.) and University of Arizona (A.A.), Phoenix, Ariz
| | - Komal Chughtai
- From the Department of Radiology, Mayo Clinic Arizona, 13400 E Shea Blvd, Scottsdale, AZ 85259 (M.Z., P.J.B., N.T., M.Y., D.V.T., A.K.); Department of Radiology, Weill Cornell Medicine, New York, NY (K.C.); Department of Pathology (P.N.) and Mallinckrodt Institute of Radiology (C.L.S.), Washington University School of Medicine in St Louis, St Louis, Mo; and Department of Radiology, Phoenix Children's Hospital (A.A., D.V.T.) and University of Arizona (A.A.), Phoenix, Ariz
| | - Pooja Navale
- From the Department of Radiology, Mayo Clinic Arizona, 13400 E Shea Blvd, Scottsdale, AZ 85259 (M.Z., P.J.B., N.T., M.Y., D.V.T., A.K.); Department of Radiology, Weill Cornell Medicine, New York, NY (K.C.); Department of Pathology (P.N.) and Mallinckrodt Institute of Radiology (C.L.S.), Washington University School of Medicine in St Louis, St Louis, Mo; and Department of Radiology, Phoenix Children's Hospital (A.A., D.V.T.) and University of Arizona (A.A.), Phoenix, Ariz
| | - Nelly Tan
- From the Department of Radiology, Mayo Clinic Arizona, 13400 E Shea Blvd, Scottsdale, AZ 85259 (M.Z., P.J.B., N.T., M.Y., D.V.T., A.K.); Department of Radiology, Weill Cornell Medicine, New York, NY (K.C.); Department of Pathology (P.N.) and Mallinckrodt Institute of Radiology (C.L.S.), Washington University School of Medicine in St Louis, St Louis, Mo; and Department of Radiology, Phoenix Children's Hospital (A.A., D.V.T.) and University of Arizona (A.A.), Phoenix, Ariz
| | - Motoyo Yano
- From the Department of Radiology, Mayo Clinic Arizona, 13400 E Shea Blvd, Scottsdale, AZ 85259 (M.Z., P.J.B., N.T., M.Y., D.V.T., A.K.); Department of Radiology, Weill Cornell Medicine, New York, NY (K.C.); Department of Pathology (P.N.) and Mallinckrodt Institute of Radiology (C.L.S.), Washington University School of Medicine in St Louis, St Louis, Mo; and Department of Radiology, Phoenix Children's Hospital (A.A., D.V.T.) and University of Arizona (A.A.), Phoenix, Ariz
| | - Asmaa Aamir
- From the Department of Radiology, Mayo Clinic Arizona, 13400 E Shea Blvd, Scottsdale, AZ 85259 (M.Z., P.J.B., N.T., M.Y., D.V.T., A.K.); Department of Radiology, Weill Cornell Medicine, New York, NY (K.C.); Department of Pathology (P.N.) and Mallinckrodt Institute of Radiology (C.L.S.), Washington University School of Medicine in St Louis, St Louis, Mo; and Department of Radiology, Phoenix Children's Hospital (A.A., D.V.T.) and University of Arizona (A.A.), Phoenix, Ariz
| | - Dane Van Tassel
- From the Department of Radiology, Mayo Clinic Arizona, 13400 E Shea Blvd, Scottsdale, AZ 85259 (M.Z., P.J.B., N.T., M.Y., D.V.T., A.K.); Department of Radiology, Weill Cornell Medicine, New York, NY (K.C.); Department of Pathology (P.N.) and Mallinckrodt Institute of Radiology (C.L.S.), Washington University School of Medicine in St Louis, St Louis, Mo; and Department of Radiology, Phoenix Children's Hospital (A.A., D.V.T.) and University of Arizona (A.A.), Phoenix, Ariz
| | - Cary Lynn Siegel
- From the Department of Radiology, Mayo Clinic Arizona, 13400 E Shea Blvd, Scottsdale, AZ 85259 (M.Z., P.J.B., N.T., M.Y., D.V.T., A.K.); Department of Radiology, Weill Cornell Medicine, New York, NY (K.C.); Department of Pathology (P.N.) and Mallinckrodt Institute of Radiology (C.L.S.), Washington University School of Medicine in St Louis, St Louis, Mo; and Department of Radiology, Phoenix Children's Hospital (A.A., D.V.T.) and University of Arizona (A.A.), Phoenix, Ariz
| | - Akira Kawashima
- From the Department of Radiology, Mayo Clinic Arizona, 13400 E Shea Blvd, Scottsdale, AZ 85259 (M.Z., P.J.B., N.T., M.Y., D.V.T., A.K.); Department of Radiology, Weill Cornell Medicine, New York, NY (K.C.); Department of Pathology (P.N.) and Mallinckrodt Institute of Radiology (C.L.S.), Washington University School of Medicine in St Louis, St Louis, Mo; and Department of Radiology, Phoenix Children's Hospital (A.A., D.V.T.) and University of Arizona (A.A.), Phoenix, Ariz
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Nezhat CR, Oskotsky TT, Robinson JF, Fisher SJ, Tsuei A, Liu B, Irwin JC, Gaudilliere B, Sirota M, Stevenson DK, Giudice LC. Real world perspectives on endometriosis disease phenotyping through surgery, omics, health data, and artificial intelligence. NPJ WOMEN'S HEALTH 2025; 3:8. [PMID: 39926583 PMCID: PMC11802455 DOI: 10.1038/s44294-024-00052-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Accepted: 12/31/2024] [Indexed: 02/11/2025]
Abstract
Endometriosis is an enigmatic disease whose diagnosis and management are being transformed through innovative surgical, molecular, and computational technologies. Integrating single-cell and other omic disease data with clinical and surgical metadata can identify multiple disease subtypes with translation to novel diagnostics and therapeutics. Herein, we present real-world perspectives on endometriosis and the importance of multidisciplinary collaboration in informing molecular, epidemiologic, and cell-specific data in the clinical and surgical contexts.
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Affiliation(s)
- Camran R. Nezhat
- Center for Special Minimally Invasive and Robotic Surgery, Camran Nezhat Institute, Stanford University Medical Center, University of California, San Francisco, Woodside, CA 94061 USA
| | - Tomiko T. Oskotsky
- Bakar Computational Health Sciences Institute, University of California San Francisco, 490 Illinois St, Floor 2, San Francisco, CA 94158 USA
| | - Joshua F. Robinson
- Center for Reproductive Sciences, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 513 Parnassus Ave, Rm. 1621, San Francisco, CA 94143 USA
| | - Susan J. Fisher
- Center for Reproductive Sciences, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, 35 Medical Center Way, Box 0665, San Francisco, CA 94143 USA
| | - Angie Tsuei
- Center for Special Minimally Invasive and Robotic Surgery, Camran Nezhat Institute, Woodside, CA 94061 USA
| | - Binya Liu
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, 513 Parnassus Avenue Room 1600 HSE, San Francisco, CA 94143 USA
| | - Juan C. Irwin
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, 513 Parnassus Avenue Room 1600 HSE, San Francisco, CA 94143 USA
| | - Brice Gaudilliere
- Department of Anesthesiology, Pain, and Perioperative Medicine, and (courtesy) Pediatrics, Stanford University, 3174 Porter Dr, Palo Alto, CA 94304 USA
| | - Marina Sirota
- Bakar Computational Health Sciences Institute, University of California San Francisco, 490 Illinois St, Floor 2, San Francisco, CA 94158 USA
| | - David K. Stevenson
- Department of Pediatrics, Stanford University, 453 Quarry Rd, Palo Alto, CA 94304 USA
| | - Linda C. Giudice
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, 513 Parnassus Avenue Room 1600 HSE, San Francisco, CA 94143 USA
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Lorente D, Tapia M, Suarez ME, Mañalich L, Trilla E. Surgical outcomes in women diagnosed with deep endometriosis involving urological structures. Actas Urol Esp 2024; 48:532-537. [PMID: 38734069 DOI: 10.1016/j.acuroe.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/01/2024] [Indexed: 05/13/2024]
Abstract
INTRODUCTION The prevalence of endometriosis is estimated to be about 10% among women of reproductive age. In about 5-10% of these patients, involvement of urological structures will be developed due to deep endometriosis. Urologists should be familiar with the management of these patients, who will require multidisciplinary care with medical and surgical treatment. MATERIAL AND METHODS Retrospective study of patients diagnosed with deep endometriosis involving urological structures who underwent surgery performed jointly with gynecology and colorectal surgery departments from June 2012 until June 2021 (60 cases). Urologic symptoms were grouped into 3 groupers for subsequent analysis (storage symptoms, voiding symptoms, and low back pain). RESULTS Storage symptoms (frequency and urgency) are the most frequent urologic symptoms. Patients with storage symptoms and low back pain showed improvement after surgery. In contrast, patients with voiding symptoms did not improve with surgical treatment. CONCLUSIONS The prevalence of endometriosis and the likelihood of involving urologic structures require the urologic community to be aware of the pathology. Patients with storage symptoms will improve following excision of the endometriotic nodules. The need for Partial cystectomies with ureteral reimplantation can be safely performed by laparoscopic or robotic approach, even in previously operated patients, without compromising long-term function.
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Affiliation(s)
- D Lorente
- Servicio de Urología, Hospital Vall d'Hebron, Barcelona, Spain.
| | - M Tapia
- Departamento de Gestión del Conocimiento y Sistemas de Información de Enfermería, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - M E Suarez
- Servicio de Ginecología, Hospital Vall d'Hebron, Barcelona, Spain
| | - L Mañalich
- Servicio de Ginecología, Hospital Vall d'Hebron, Barcelona, Spain
| | - E Trilla
- Servicio de Urología, Hospital Vall d'Hebron, Barcelona, Spain
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5
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Senthilkumar S, Morgan T, Wasson MN. Posthysterectomy Retroperitoneal Endometrioma With Episodic Bleeding. J Minim Invasive Gynecol 2024; 31:635-637. [PMID: 38772439 DOI: 10.1016/j.jmig.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/04/2024] [Accepted: 05/06/2024] [Indexed: 05/23/2024]
Affiliation(s)
- Sanjanaa Senthilkumar
- Department of Medical and Surgical Gynecology (Ms. Senthilkumar and Dr. Wasson), Mayo Clinic in Arizona, Phoenix, Arizona; Mayo Clinic Alix School of Medicine (Ms. Senthilkumar), Mayo Clinic in Arizona, Phoenix, Arizona.
| | - Tara Morgan
- Department of Radiology (Dr. Morgan), Mayo Clinic in Arizona, Phoenix, Arizona
| | - Megan N Wasson
- Department of Medical and Surgical Gynecology (Ms. Senthilkumar and Dr. Wasson), Mayo Clinic in Arizona, Phoenix, Arizona
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Takeuchi M, Matsuzaki K, Harada M. Endometriosis, a common but enigmatic disease with many faces: current concept of pathophysiology, and diagnostic strategy. Jpn J Radiol 2024; 42:801-819. [PMID: 38658503 PMCID: PMC11286651 DOI: 10.1007/s11604-024-01569-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/06/2024] [Indexed: 04/26/2024]
Abstract
Endometriosis is a benign, common, but controversial disease due to its enigmatic etiopathogenesis and biological behavior. Recent studies suggest multiple genetic, and environmental factors may affect its onset and development. Genomic analysis revealed the presence of cancer-associated gene mutations, which may reflect the neoplastic aspect of endometriosis. The management has changed dramatically with the development of fertility-preserving, minimally invasive therapies. Diagnostic strategies based on these recent basic and clinical findings are reviewed. With a focus on the presentation of clinical cases, we discuss the imaging manifestations of endometriomas, deep endometriosis, less common site and rare site endometriosis, various complications, endometriosis-associated tumor-like lesions, and malignant transformation, with pathophysiologic conditions.
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Affiliation(s)
- Mayumi Takeuchi
- Department of Radiology, Tokushima University, 3-18-15, Kuramoto-Cho, Tokushima, 7708503, Japan.
| | - Kenji Matsuzaki
- Department of Radiological Technology, Tokushima Bunri University, Sanuki City, ShidoKagawa, 1314-17692193, Japan
| | - Masafumi Harada
- Department of Radiology, Tokushima University, 3-18-15, Kuramoto-Cho, Tokushima, 7708503, Japan
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Nimodia D, Parihar P, Banode P, Dudhe SS, Desale P, Gaur S. Hidden Depths: Unveiling Endometriosis in the Canal of Nuck. Cureus 2024; 16:e64975. [PMID: 39161483 PMCID: PMC11333021 DOI: 10.7759/cureus.64975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 07/19/2024] [Indexed: 08/21/2024] Open
Abstract
Endometriosis located within the canal of Nuck represents a highly uncommon occurrence, often posing a diagnostic challenge due to its atypical site and varied clinical presentations. The case of a 31-year-old female who presented with groin swelling and subsequent suprapubic pain for a duration of two years is described in this study. Utilizing magnetic resonance imaging (MRI), a cystic lesion was detected within the canal of Nuck, raising suspicion of endometriosis. Surgical exploration confirmed the presence of endometrial implants, supporting the initial radiological findings. This particular case emphasizes the significance of imaging techniques in diagnosing endometriosis in unusual sites, thereby enabling timely interventions and enhancing patient outcomes. Furthermore, it underscores the necessity of a multidisciplinary approach involving radiologists, gynecologists, and surgeons in ensuring comprehensive care for such patients. In the subsequent sections, we endeavor to present a unique instance of endometriosis within the canal of Nuck, a condition scarcely documented in the existing global literature. Our objective is to heighten awareness and encourage the consideration of endometriosis as a potential differential diagnosis in females presenting with inguinal masses and pelvic discomfort.
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Affiliation(s)
- Devyansh Nimodia
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pratapsingh Parihar
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pankaj Banode
- Interventional Radiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sakshi S Dudhe
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Prasad Desale
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shubhi Gaur
- Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Liang Y, Mei L, Ning Q, Zhang J, Fei J, Dong J. A Case of Rectal Endometriosis Misdiagnosed as Rectal Malignancy on Three Colonoscopies and Biopsies Sharing a Combined Literature Review. Int J Womens Health 2024; 16:163-174. [PMID: 38292299 PMCID: PMC10826710 DOI: 10.2147/ijwh.s445280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 01/11/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Endometriosis involves the intestine, and its clinical manifestations are nonspecific and lack of etiological manifestations. The diagnosis is difficult, which often leads to misdiagnosis. We report a case of endometriosis which was misdiagnosed as intestinal malignant tumor after colonoscopy and three biopsies. CASE PRESENTATION We reported a 42-year-old woman who went to see a doctor because of anal distension. She was examined by three gastrointestinal endoscopists at different levels in different hospitals and underwent biopsy at the same time. Combined with clinical manifestations, imaging examination, endoscopic examination and pathological examination, she was misdiagnosed as intestinal malignant tumor, and partial intestinal resection was performed according to the surgical principle of malignant tumor. CONCLUSION Although there are advanced gastrointestinal endoscopy and imaging techniques, intestinal endometriosis is still easy to be misdiagnosed. As our case report shows, after three colonoscopy and biopsy, it is still misdiagnosed as intestinal malignant tumor. Further research is needed to improve the ability of preoperative diagnosis, which deserves the attention of gastroenterologists and obstetricians and gynecologists.
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Affiliation(s)
- Yufei Liang
- Department of Gynaecology and Obstetrics, Huzhou Maternity & Child Health Care Hospital, Huzhou, People’s Republic of China
| | - Lina Mei
- Department of Digestive, Huzhou Maternity & Child Health Care Hospital, Huzhou, People’s Republic of China
| | - Qipeng Ning
- Department of Digestive, Huzhou Maternity & Child Health Care Hospital, Huzhou, People’s Republic of China
| | - Jiao Zhang
- Department of Digestive, Huzhou Maternity & Child Health Care Hospital, Huzhou, People’s Republic of China
| | - Jingying Fei
- Department of Ultrasound, Huzhou Maternity & Child Health Care Hospital, Huzhou, People’s Republic of China
| | - Jie Dong
- Department of Gynaecology and Obstetrics, Huzhou Maternity & Child Health Care Hospital, Huzhou, People’s Republic of China
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Paspulati RM. Chronic Pelvic Pain: Role of Imaging in the Diagnosis and Management. Semin Ultrasound CT MR 2023; 44:501-510. [PMID: 37879545 DOI: 10.1053/j.sult.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
Chronic pelvic pain (CPP) in women is not uncommon, and it may be difficult to identify the exact cause difficult to manage. It is major health problem for women that affects the quality of their daily lives. The etiology of chronic pelvic pain may be of gynecological or non-gynecological origin and associated with several predisposing and precipitating factors. Psychological and social factors also contribute to the syndrome of CPP and must be evaluated before managing these patients. Due to multifactorial etiology, CPP needs a multidisciplinary approach for diagnosis and management. A detailed history and physical examination supported by appropriate laboratory tests and imaging are the keys to diagnosis. In this paper, the role of imaging in diagnosis and management of CPP is reviewed. Imaging findings should be correlated with detailed clinical examination findings as there are imaging findings that may be unrelated and not the cause of CPP in a particular patient, imaging findings should be correlated with the clinical circumstances.
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Affiliation(s)
- Raj Mohan Paspulati
- Department of Diagnostic and Interventional Radiology, Moffitt Cancer Center, Tampa, Florida; Department of Medical Oncology, University of South Florida, Tampa, Florida.
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10
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Guseva AI. Bladder endometriosis. Clinical case and literature review. UROLOGY REPORTS (ST. - PETERSBURG) 2023; 13:197-203. [DOI: 10.17816/uroved108019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
Abstract
The article presents information about the clinical manifestations, diagnosis and treatment of bladder endometriosis. The issues of etiology and pathogenesis of endometriosis are considered in detail. The classification of extragenital endometriosis is given. Information about the prevalence of endometriosis of the urinary system is given. A clinical observation of a patient with endometriosis of the bladder that developed after surgery on the pelvic organs is presented.
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11
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Xu Y, Yao Y, Pylypenko D, Xu X, Li S, Wang Q. Diagnosis of pelvic endometriosis: a preliminary study on the added value of R2*MFGRE sequence in magnetic resonance imaging. Acta Radiol 2023; 64:1255-1262. [PMID: 35938205 DOI: 10.1177/02841851221117260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Identifying and locating endometriotic lesions is crucial for preoperative planning, so new magnetic resonance imaging (MRI) techniques are urgently needed to improve the diagnostic sensitivity for pelvic endometriosis. PURPOSE To evaluate the feasibility of R2* multiple fast gradient recalled echo (MFGRE) imaging in the diagnosis of pelvic endometriosis. MATERIAL AND METHODS A total of 46 patients with suspected endometriosis underwent routine pelvic MRI and R2*MFGRE imaging. Clinical diagnosis was pathologically confirmed one month after MRI examination. Three radiologists who were blinded to the pathological results evaluated the number of ovarian endometriomas (OMAs) and deep infiltrating endometriosis (DIE) lesions using routine MRI and its combination with R2*MFGRE. The diagnostic sensitivity for OMA or DIE using the two examination methods was determined. Two-correlation sample rank-sum tests were used to compare both methods. Additionally, for all lesions, the R2* values were measured and statistically analyzed. RESULTS Among 46 patients, 47 OMAs and 30 DIE lesions were found surgically and pathologically confirmed. The diagnostic sensitivity of the routine MRI was 87.2% for OMA and 46.7% for DIE. The diagnostic sensitivity of the routine imaging combined with R2*MFGRE was 100% for OMA and 90% for DIE. The two-correlation sample rank-sum test showed a significant difference between both methods (P<0.01, z = -4.26). The median R2* value was 25.20 (IQR=14) for the OMA group, and 45.21 (IQR=40) for the DIE group. The difference between both groups was statistically significant (P<0.01, z = -4.89). CONCLUSION R2*MFGRE imaging, as a supplement to the routine MRI, could improve the diagnostic sensitivity for pelvic endometriosis, especially for DIE.
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Affiliation(s)
- Yifan Xu
- Department of Radiology, 66310The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, PR China
| | - Yuan Yao
- Department of Radiology, 91623Qilu Hospital of Shandong University, Jinan, PR China
| | | | - Xinghua Xu
- Department of Radiology, 91623Qilu Hospital of Shandong University, Jinan, PR China
| | - Shuyi Li
- Department of Radiology, 91623Qilu Hospital of Shandong University, Jinan, PR China
| | - Qing Wang
- Department of Radiology, 91623Qilu Hospital of Shandong University, Jinan, PR China
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Quesada J, Härmä K, Reid S, Rao T, Lo G, Yang N, Karia S, Lee E, Borok N. Endometriosis: A multimodal imaging review. Eur J Radiol 2023; 158:110610. [PMID: 36502625 DOI: 10.1016/j.ejrad.2022.110610] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/07/2022] [Accepted: 11/10/2022] [Indexed: 11/17/2022]
Abstract
Endometriosis is a chronic inflammatory disorder characterized endometrial-like tissue present outside of the uterus, affecting approximately 10% of reproductive age women. It is associated with abdomino-pelvic pain, infertility and other non - gynecologic symptoms, making it a challenging diagnosis. Several guidelines have been developed by different international societies to diagnose and classify endometriosis, yet areas of controversy and uncertainty remains. Transvaginal ultrasound (TV-US) is the first-line imaging modality used to identify endometriosis due to its accessibility and cost-efficacy. Enhanced sonographic techniques are emerging as a dedicated technique to evaluate deep infiltrating endometriosis (DIE), depending on the expertise of the sonographer as well as the location of the lesions. MRI is an ideal complementary modality to ultrasonography for pre-operative planning as it allows for a larger field-of-view when required and it has high levels of reproducibility and tolerability. Typically, endometriotic lesions appear hypoechoic on ultrasonography. On MRI, classical features include DIE T2 hypointensity, endometrioma T2 hypointensity and T1 hyperintensity, while superficial peritoneal endometriosis (SPE) is described as a small focus of T1 hyperintensity. Imaging has become a critical tool in the diagnosis, surveillance and surgical planning of endometriosis. This literature review is based mostly on studies from the last two decades and aims to provide a detailed overview of the imaging features of endometriosis as well as the advances and usefulness of different imaging modalities for this condition.
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Affiliation(s)
- Juan Quesada
- Department of Obstetrics & Gynecology, Campbelltown Hospital (South-Western Sydney Local Health District), Terry Rd, Campbelltown, NSW 2560, Australia.
| | - Kirsi Härmä
- Department of Diagnostic, Interventional and Pediatric Radiology - University Hospital of Bern, Inselspital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.
| | - Shannon Reid
- Western Sydney University, Faculty of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia; Sonacare Women's Health and Ultrasound, Harrington, NSW 2567, Australia
| | - Tanushree Rao
- Department of Obstetrics & Gynecology at Liverpool Hospital, Liverpool Hospital, Locked Bag 7103, Liverpool BC, NSW 1871, Australia
| | - Glen Lo
- Department of Radiology, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA 6009, Australia; The Western Ultrasound for Women, 1/160a Cambridge St, West Leederville, Perth, WA 6007, Australia.
| | - Natalie Yang
- Department of Radiology, The Austin Hospital, 145 Studley Rd, Heidelberg, Victoria 3084, Australia.
| | - Sonal Karia
- Department of Obstetrics & Gynecology, Campbelltown Hospital (South-Western Sydney Local Health District), Terry Rd, Campbelltown, NSW 2560, Australia.
| | - Emmeline Lee
- Department of Radiology, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA 6009, Australia; The Western Ultrasound for Women, 1/160a Cambridge St, West Leederville, Perth, WA 6007, Australia
| | - Nira Borok
- Department of Radiology, Liverpool Hospital, Locked Bag 7103, Liverpool BC, NSW 1871, Australia.
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Testini V, Eusebi L, Grechi G, Bartelli F, Guglielmi G. Imaging of Endometriosis: The Role of Ultrasound and Magnetic Resonance. CURRENT RADIOLOGY REPORTS 2022. [DOI: 10.1007/s40134-022-00393-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AbstractEndometriosis is a chronic gynecological disease characterized by the growth of functional ectopic endometrial glands and stroma outside the uterus. It causes pelvic pain, dysmenorrhea, dyspareunia, or infertility. Diagnosis requires a combination of clinical history, non-invasive and invasive techniques. The aim of the present review was to evaluate the contribution of imaging techniques, mainly transvaginal sonography and magnetic resonance imaging to diagnose different locations and for the most appropriate treatment planning. Endometriosis requires a multidisciplinary teamwork to manage these patients clinically and surgically.
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Makhovsky VZ, Aksenenko VA, Makhovsky VV, Aksenenko DV, Kuyumcheva KK, Yurin SV. [Emergency combined surgery for acute appendicitis and cystic lesions of small pelvis]. Khirurgiia (Mosk) 2022:30-37. [PMID: 35146997 DOI: 10.17116/hirurgia202202130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine the optimal surgical approach for acute appendicitis and concomitant cystic lesions of small pelvis. MATERIAL AND METHODS The authors report the results of emergency combined surgery on abdominal and pelvic organs in 995 patients for the period from 1990 to 2020 (30 years). Acute appendicitis was diagnosed in 698 (70.15%) patients. Cystic lesions of small pelvis were observed in 286 (28.7%) patients: follicular cyst - 133 (46.5%), serous cyst - 91 (31.8%), corpus luteum cyst - 42 (46.4%), dermoid cyst - 20 (7.0%), endometrioid cyst - 3 (1.0%) cases. Catarrhal appendicitis was diagnosed in 10 (1.4%) patients, phlegmonous appendicitis - 685 (98.1%), gangrenous appendicitis - 3 (0.4%) patients. All patients with pyoinflammatory diseases of small pelvis had long-term history of gynecological diseases. RESULTS Cystic lesions of small pelvis can undergo malignant transformation. Therefore, surgical intervention is determined by surgeon together with gynecologist. Tree large endometrioid cysts (20-25 cm) were malignant. These patients also had adenocarcinoma of sigmoid colon. Malignant neoplasm resulted acute ileus, and the cysts were incorporated into pyogenic membrane. Extensive adhesive process was also observed. These aspects caused significant technical difficulties during resection of these cysts. Postoperative complications occurred in 2.31% of patients. CONCLUSION Prolonged therapy and follow-up of patients with urgent concomitant inflammatory diseases of abdominal cavity and small pelvis (chronic nonspecific salpingitis, diffuse pelvic endometriosis, ovarian cysts, etc.) can lead to development and growth of cystic lesions of small pelvis. These cysts may be complicated by subsequent malignant transformation.
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Affiliation(s)
- V Z Makhovsky
- Stavropol State Medical University, Stavropol, Russia
| | - V A Aksenenko
- Stavropol State Medical University, Stavropol, Russia
| | - V V Makhovsky
- Polyclinic No. 1 of the Presidential Administration, Moscow, Russia
| | - D V Aksenenko
- Stavropol State Medical University, Stavropol, Russia
| | | | - S V Yurin
- Stavropol Regional Clinical Hospital, Stavropol, Russia
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Siddiqui S, Bari V. Accuracy of MRI Pelvis in the Diagnosis of Ovarian Endometrioma: Using Histopathology as Gold Standard. Cureus 2021; 13:e20650. [PMID: 35103206 PMCID: PMC8783948 DOI: 10.7759/cureus.20650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2021] [Indexed: 11/05/2022] Open
Abstract
Background Endometriosis is defined as the ectopic presence of endometrial mucosa at locations other than the uterine cavity. It results in significant morbidity and is a leading cause of infertility as well. Magnetic resonance imaging (MRI) is establishing its role in the diagnosis of endometriosis and its complications. The objective of this study was to assess the accuracy of MRI in the diagnosis of ovarian endometriosis using histopathology as the gold standard. Materials and methods All patients presenting with clinical complaints and suspicion of endometriosis, undergoing MRI followed by surgical resection and confirmation by histopathology, were included in the study. Data were analyzed on a predefined proforma and parameters of accuracy were calculated. Results A total of 170 patients were included in this study, having a mean age of 36.8 years with a standard deviation of 10.4 years. The mean parity for included subjects was 2.25, with a standard deviation of 1.3. Overall, the sensitivity of MRI was 86.7% and the specificity was 81.9%. The positive predictive value (PPV) of MRI was 83.3%, while the negative predictive value (NPV) was 81.9%. Overall, the diagnostic accuracy of MRI was 84.7%. Conclusion The accuracy of MRI in the diagnosis of endometriosis was found to be acceptable and comparable to most of the worldwide published literature. The routine use of MRI for diagnosis and preoperative planning is justified by the results of this study.
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Hughes NJ, Kalkur S, Zhang J, Liyanage SH. Patient acceptability and quality of self-administered intravaginal gel for pelvic MRI. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2021. [DOI: 10.1177/22840265211065223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: MRI of the pelvis can be limited for infiltrating lesions or those of same signal intensity as surrounding structures. Vaginal distension using aqueous gel counters this by defining the fornices, cervix and anterior rectal wall. This increases the accuracy of diagnosis and staging of various pelvic pathology, however, there is currently neither a universally accepted protocol for using gel nor focus on patient self-administration. Aims: To improve patient expectations regarding pelvic MRI with intravaginal gel, as well as the service we provide should they prefer self-administration and this produces vaginal distension of radiological quality equivalent to doctor-administration. Methods: Illustrated information explaining the benefits of gel and the technique of self-administration was sent to patients scheduled for pelvic MRI between March 2020 and April 2021 at our study centre. This included a questionnaire to assess understanding and preference for self-administration. Vaginal distension achieved on imaging was analysed using TeraRecon and compared between self and doctor-administered cases. Results: 38 of 45 patients opted for self-administration of gel. Those who identified as White British were more likely to self-administer. There was comparable quality of vaginal distension between self and doctor administered cases, with no significant difference between orthogonal measurements and retained gel volume. Conclusion: Self-administration of intravaginal gel for pelvic MRI is acceptable to patients and frees a doctor of this duty. It is a well tolerated technique which produces high quality vaginal distention on imaging. We recommend wider use of intravaginal and even rectal gel in the investigation of complex endometriosis and pelvic tumours.
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Affiliation(s)
- Noemi J Hughes
- Department of Obstetrics and Gynaecology, Southend University Hospital NHS Foundation Trust, Southend-on-Sea, UK
| | - Sanjaya Kalkur
- Department of Obstetrics and Gynaecology, Southend University Hospital NHS Foundation Trust, Southend-on-Sea, UK
| | | | - Sidath H Liyanage
- Department of Radiology, Southend University Hospital NHS Foundation Trust, Southend-on-Sea, UK
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17
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Abstract
Teaching Point: Magnetic resonance imaging allows adequate evaluation of the location, size and subperitoneal lesion extension of deep pelvic endometriosis, providing key information for both the diagnosis and treatment planning.
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Alvarado LER, Bahmad H, Mejia O, Hollembeak H, Poppiti R, Howard L, Muddasani K. Rectal endometriosis presenting as toxic megacolon. AUTOPSY AND CASE REPORTS 2021; 11:e2021319. [PMID: 34540725 PMCID: PMC8432386 DOI: 10.4322/acr.2021.319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/09/2021] [Indexed: 11/23/2022] Open
Abstract
Background The bowel is the most common site of extragenital endometriosis, with involvement of the locoregional sigmoid colon and anterior rectum seen most often. The clinical presentation varies depending on how soon patients seek medical care, thus requiring changes in management strategies. Endometriosis can cause a life-threatening surgical emergency with progressive obliteration of the bowel lumen leading to obstruction and late complications including toxic megacolon and transmural necrosis. Case presentation We report the case of a 41-year-old woman presenting with an acute abdomen and complete large bowel obstruction complicated by sepsis and toxic megacolon. The patient underwent emergency total colectomy with ileostomy. Medical history was significant for chronic, vague, and episodic lower abdominal pain self-medicated with herbal tea and laxatives. Pathologic examination demonstrated colonic endometriosis within the bowel wall as the cause of obstruction, ischemia, and transmural necrosis. Conclusions Although a rare clinical entity, this case highlights two important points. First, it demonstrates the value of performing proper and complete clinical work up to rule out or in all possible causes of colonic obstruction, including intestinal endometriosis. Second, it suggests a potential benefit of a formalized multidisciplinary approach, including surgery, in the management of medically unresponsive endometriosis. In conclusion, this case shows that endometriosis can cause life-threatening colonic obstruction in women of childbearing age. Prompt early intervention is warranted, particularly when obstruction is only partial and ischemia has not supervened, to conceivably prevent the development of a toxic megacolon requiring colectomy and avoid late complications.
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Affiliation(s)
| | - Hisham Bahmad
- Mount Sinai Medical Center, The Arkadi M. Rywlin M.D. Department of Pathology and Laboratory Medicine, Miami Beach, FL, USA
| | - Odille Mejia
- Mount Sinai Medical Center, The Arkadi M. Rywlin M.D. Department of Pathology and Laboratory Medicine, Miami Beach, FL, USA
| | - Heather Hollembeak
- Mount Sinai Medical Center, Department of General Surgery, Miami Beach, FL, USA
| | - Robert Poppiti
- Mount Sinai Medical Center, The Arkadi M. Rywlin M.D. Department of Pathology and Laboratory Medicine, Miami Beach, FL, USA.,Florida International University, Herbert Wertheim College of Medicine, Miami, FL, USA
| | - Lydia Howard
- Mount Sinai Medical Center, The Arkadi M. Rywlin M.D. Department of Pathology and Laboratory Medicine, Miami Beach, FL, USA
| | - Kiranmayi Muddasani
- Mount Sinai Medical Center, Department of General Surgery, Miami Beach, FL, USA
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Sud S, Buxi TBS, Sheth S, Ghuman SS. Endometriosis and Its Myriad Presentations: Magnetic Resonance Imaging-Based Pictorial Review. Indian J Radiol Imaging 2021; 31:193-202. [PMID: 34316127 PMCID: PMC8299511 DOI: 10.1055/s-0041-1729670] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Endometriosis is a major cause of infertility and pain in females in the reproductive age group. It is a result of ectopic functional endometrial cells outside the uterus. It consists of a spectrum of findings from superficial to deep implants initiating a fibrotic response and resulting in adhesions. Diagnosis of endometriosis is based on clinical history, noninvasive and invasive techniques. The final diagnosis is based on laparoscopy with histopathological confirmation. Ultrasonography is the first line of investigation, followed by magnetic resonance imaging (MRI) in complex cases. MRI is a noninvasive, multiplanar technique that involves no radiation and provides excellent delineation of the disease process. As deep endometriosis has a similar low signal to adjacent normal organs, it can be easily overlooked by radiologists. They should be aware of the spectrum of diseases so as to provide a roadmap for the surgeons. A structured reporting system helps radiologists organize and standardize their reports.
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Affiliation(s)
- Seema Sud
- Department of CT and MRI, Sir Ganga Ram Hospital, New Delhi, India
| | | | - Swapnil Sheth
- Department of CT and MRI, Sir Ganga Ram Hospital, New Delhi, India
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20
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Bordonné C, Puntonet J, Maitrot-Mantelet L, Bourdon M, Marcellin L, Dion E, Plu-Bureau G, Santulli P, Chapron C. Imaging for evaluation of endometriosis and adenomyosis. Minerva Obstet Gynecol 2021; 73:290-303. [PMID: 34008384 DOI: 10.23736/s2724-606x.21.04710-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Endometriosis and adenomyosis are two frequent diseases that impair women's quality of life by causing pain and infertility. Both endometriosis and adenomyosis are heterogeneous diseases that manifest as different forms. Adenomyosis may be described as diffuse adenomyosis, focal adenomyosis especially of the outer myometrium and cystic adenomyoma. Endometriosis has three phenotypes: superficial peritoneal endometriosis (SUP), ovarian endometrioma (OMA), and deep infiltrating endometriosis (DIE). These two diseases are closely linked, and it is now clear that adenomyosis can either arise on its own or coexist with endometriosis. There is a strong clinical relationship between endometriosis and adenomyosis according to their respective phenotypes. Various classifications are available to describe both diseases. Transvaginal ultrasonography (TVUS) and/or pelvic magnetic resonance imaging (MRI) are the first examination performed when endometriosis or adenomyosis are suspected. These two imaging techniques, used in a combination manner, allow accurate description of both endometriosis and adenomyosis, to assess the diagnosis and to improve clinical and surgical care. In this review, we described the different imaging aspects of endometriosis and adenomyosis to help the less experienced radiologist or gynecologist in the diagnosis and evaluation of those diseases.
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Affiliation(s)
- Corinne Bordonné
- Section of Radiology, APHP - Centre Hospitalier Universitaire (CHU) Hôtel-Dieu, Paris, France - .,Faculty of Medicine, University of Paris, Paris, France -
| | - Julien Puntonet
- Section of Radiology, APHP - Centre Hospitalier Universitaire (CHU) Hôtel-Dieu, Paris, France.,Faculty of Medicine, University of Paris, Paris, France
| | - Lorraine Maitrot-Mantelet
- Section of Obstetrics and Gynecology II and of Reproduction Medicine, APHP - Centre Hospitalier Universitaire (CHU) Cochin, Paris, France.,Department of Infection, Immunity and Inflammation, INSERM, Cochin Institute, University of Paris, Paris, France
| | - Mathilde Bourdon
- Faculty of Medicine, University of Paris, Paris, France.,Section of Obstetrics and Gynecology II and of Reproduction Medicine, APHP - Centre Hospitalier Universitaire (CHU) Cochin, Paris, France.,Department of Infection, Immunity and Inflammation, INSERM, Cochin Institute, University of Paris, Paris, France
| | - Louis Marcellin
- Faculty of Medicine, University of Paris, Paris, France.,Section of Obstetrics and Gynecology II and of Reproduction Medicine, APHP - Centre Hospitalier Universitaire (CHU) Cochin, Paris, France.,Department of Infection, Immunity and Inflammation, INSERM, Cochin Institute, University of Paris, Paris, France
| | - Elisabeth Dion
- Section of Radiology, APHP - Centre Hospitalier Universitaire (CHU) Hôtel-Dieu, Paris, France.,Faculty of Medicine, University of Paris, Paris, France
| | - Geneviève Plu-Bureau
- Section of Obstetrics and Gynecology II and of Reproduction Medicine, APHP - Centre Hospitalier Universitaire (CHU) Cochin, Paris, France.,Department of Infection, Immunity and Inflammation, INSERM, Cochin Institute, University of Paris, Paris, France
| | - Pietro Santulli
- Faculty of Medicine, University of Paris, Paris, France.,Section of Obstetrics and Gynecology II and of Reproduction Medicine, APHP - Centre Hospitalier Universitaire (CHU) Cochin, Paris, France.,Department of Infection, Immunity and Inflammation, INSERM, Cochin Institute, University of Paris, Paris, France
| | - Charles Chapron
- Faculty of Medicine, University of Paris, Paris, France.,Section of Obstetrics and Gynecology II and of Reproduction Medicine, APHP - Centre Hospitalier Universitaire (CHU) Cochin, Paris, France.,Department of Infection, Immunity and Inflammation, INSERM, Cochin Institute, University of Paris, Paris, France
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Celli V, Ciulla S, Dolciami M, Satta S, Ercolani G, Porpora MG, Catalano C, Manganaro L. Magnetic Resonance Imaging in endometriosis-associated pain. Minerva Obstet Gynecol 2021; 73:553-571. [PMID: 33904689 DOI: 10.23736/s2724-606x.21.04782-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Endometriosis affects 10%-15% of women in reproductive age and may cause no-cyclic chronic pelvic pain, dysmenorrhea, dyspareunia, urinary tract symptoms, and it is frequently associated with infertility. The peak of incidence is between 24 and 29 years old and the clinical diagnosis of endometriosis is generally delayed by 6-7 years. Laparoscopy with surgical biopsies is the "gold standard" for the diagnosis of endometriosis, with histological verification of endometrial ectopic glands and/or stroma. However, nowadays two different non-invasive modalities are routinely used for a presumptive diagnosis: Transvaginal Ultrasound (TVUS) and Magnetic Resonance Imaging (MRI). EVIDENCE ACQUISITION A structured search using PubMed was performed starting from October 2020 and including all relevant original and review articles published since 2000. The search used the following key word combinations: "Endometriosis MRI" AND "DIE and MRI" (45); "MRI endometriosis and Pelvic Pain" OR "Endometriosis and MRI technical development" (296). Ultimately, 87 articles were deemed relevant and used as the literature basis of this review. EVIDENCE SYNTHESIS TVUS represents the first imaging approach for endometriosis showing a good diagnostic performance but it is highly operator dependent. MRI is a second level examination often used in complex cases indeterminate after TVUS and in pre-operative planning. MRI is considered the best imaging technique for mapping endometriosis since it provides a more reliable map of deep infiltrating endometriosis than physical examination and transvaginal ultrasound. We have analyzed and described the main forms of endometriosis: adnexal endometriosis, adenomyosis, peritoneal implants and deep infiltrating endometriosis, showing their appearance in the two imaging modalities. CONCLUSIONS Endometriosis is one of the most common gynecologic disorders correlated to chronic pelvic pain whose treatment is still today complex and controversial. In this context, MRI has become an important additional non-invasive tool to investigate cases of chronic pelvic pain related to deep infiltrating endometriosis (DIE) with or without neural involvement.
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Affiliation(s)
- Veronica Celli
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy
| | - Sandra Ciulla
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy
| | - Miriam Dolciami
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy
| | - Serena Satta
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy
| | - Giada Ercolani
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy
| | - Maria G Porpora
- Department of Maternal and Child Health and Urological Sciences, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy
| | - Lucia Manganaro
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza, University of Rome, Rome, Italy - lucia.manganaro@uniroma1
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Bruyere C, Maniou I, Habre C, Kalovidouri A, Pluchino N, Montet X, Botsikas D. Pelvic MRI for Endometriosis: A Diagnostic Challenge for the Inexperienced Radiologist. How Much Experience Is Enough? Acad Radiol 2021; 28:345-353. [PMID: 32241715 DOI: 10.1016/j.acra.2020.02.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/24/2020] [Accepted: 02/24/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The purpose of this study was to investigate the impact of radiologist experience on diagnostic performance of pelvic magnetic resonance imaging (MRI) for the evaluation of endometriomas and different localisations of deep pelvic endometriosis (DPE). MATERIALS AND METHODS In this prospective study all pelvic MRI examinations performed for pelvic endometriosis from December 2016 to August 2017 were evaluated by readers with different experience levels; junior resident (0-6 weeks of experience in female imaging), senior resident (7-24 weeks), fellow (6-24 months), and expert (10 years) in female imaging for the presence of endometriomas and DPE. Their evaluations were compared with surgery confirmed with pathology. Diagnostic performances of readers with different levels of experience were studied by the means of receiving operating characteristic curves and areas under the curve (AUC) were compared with the ones of the expert reader. RESULTS Of 174 patients evaluated, the standard of reference was available for 59, consisting the final population of the study. The AUC for endometriomas, DPE for the posterior and anterior pelvic compartment, for rectosigmoid DPE and for overall evaluation were 0.983, 0.921, 0.615, 0.862, and 0.914 for the expert reader, 0.966 (p = 0.178), 0.805 (p = 0.001), 0.605 (p = 0.91), 0.872 (p = 0.317), and 0.849 (p = 0.0009) for the fellow level, 0.877 (p = 0.002), 0.757 (p < 0.001), 0.585 (p = 0.761), 0.744 (p = 0.239), and 0.787 (p = < 0.001) for the senior resident level and 0.861 (p = 0.177), 0.649 (p < 0.001), 0.648 (p = 0.774), 0.862 (p = 1), and 0.721 (p < 0.001) for the junior resident level. CONCLUSIONS According to our results, interpretation of pelvic MRI for DPE should be performed by specialists as; even the performance of radiologists with up to 2 years of experience in female imaging was statistically inferior to that of experts.
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MRI of intestinal endometriosis. Best Pract Res Clin Obstet Gynaecol 2021; 71:51-63. [DOI: 10.1016/j.bpobgyn.2020.05.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/11/2020] [Indexed: 12/28/2022]
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Huang J, Chen X, Lv Y. HMGB1 Mediated Inflammation and Autophagy Contribute to Endometriosis. Front Endocrinol (Lausanne) 2021; 12:616696. [PMID: 33815277 PMCID: PMC8018282 DOI: 10.3389/fendo.2021.616696] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 02/23/2021] [Indexed: 11/13/2022] Open
Abstract
AIM High mobility group box (HMGB)-1 has been implicated in endometriosis due to the important regulatory roles of inflammation in endometriosis. The aim of the present study was to explore the roles of HMGB-1 in endometriosis and to elucidate the underlying mechanism. METHODS Endometrial specimens were collected from women with endometriosis and healthy volunteers. Immunohistochemistry staining was used to determine the expression patterns and localization of HMGB-1 in the normal, eutopic and ectopic endometrial tissues. Western blotting and qRT-PCR were used to determine the mRNA and protein levels of inflammatory cytokines [interleukin (IL)-6, tumor necrosis factor (TNF)-α and IL-1β], autophagy-related markers [beclin-1, autophagy-related (atg)13, microtubule-associated protein light chain (LC)3-I, LC-II and p62] and HMGB-1, respectively. Spearman's rank correlation analysis was employed to investigate the correlation between HMGB-1 with inflammatory cytokines and beclin-1. Besides, human endometrial stromal cells (HESCs) were isolated from ectopic endometrium and subsequently transfected with shRNA against HMGB-1. After the transfected cells were subjected to hypoxia, ELISA was used to determine the levels of HMGB-1 and inflammatory cytokines in the cell supernatant. Western blotting was used to determine the expression levels of autophagy-related markers in the cells. RESULTS Positive correlations were observed between HMGB-1 and the inflammatory cytokines. In addition, a positive correlation was also identified between HMGB-1 and beclin-1 in the ectopic endometrium. Further results demonstrated that autophagy-related markers beclin-1, atg13 and p62 were significantly upregulated in the ectopic endometrium. In addition, HMGB-1 knockdown suppressed the levels of inflammatory cytokines IL-6, TNF-α and IL-1β and autophagy-related markers beclin-1 and atg13, while upregulated p62 in HESCs under hypoxic condition. CONCLUSION Knockdown of HMGB-1 under hypoxic condition regulated inflammatory cytokines and autophagy-related markers. HMGB-1 might contribute to the development of endometriosis in part through regulating inflammatory response and autophagy.
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Singh S, Naik S, Sethi P, Panigrahi MK. Spontaneous Hemoperitoneum in Endometriosis: A Case Report. J Gynecol Surg 2020. [DOI: 10.1089/gyn.2020.0045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Sweta Singh
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Suprava Naik
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Pruthwiraj Sethi
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Manas Kumar Panigrahi
- Department of Gastroenterology, All India Institute of Medical Sciences, Bhubaneswar, India
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Bielen D, Tomassetti C, Van Schoubroeck D, Vanbeckevoort D, De Wever L, Van den Bosch T, D'Hooghe T, Bourne T, D'Hoore A, Wolthuis A, Van Cleynenbreughel B, Meuleman C, Timmerman D. IDEAL study: magnetic resonance imaging for suspected deep endometriosis assessment prior to laparoscopy is as reliable as radiological imaging as a complement to transvaginal ultrasonography. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 56:255-266. [PMID: 31503381 DOI: 10.1002/uog.21868] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 07/18/2019] [Accepted: 08/27/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To compare the value of using one-stop magnetic resonance imaging (MRI) vs standard radiological imaging as a supplement to transvaginal ultrasonography (TVS) for the preoperative assessment of patients with endometriosis referred for surgery in a tertiary care academic center. METHODS This prospective observational study compared the diagnostic value of the standard preoperative imaging practice of our center, which involves expert TVS complemented by intravenous urography (IVU) for the evaluation of the ureters and double-contrast barium enema (DCBE) for the evaluation of the rectum, sigmoid and cecum, with that of expert TVS complemented by a 'one-stop' MRI examination evaluating the upper abdomen, pelvis, kidneys and ureters as well as rectum and sigmoid on the same day, for the preoperative triaging of 74 women with clinically suspected deep endometriosis. The findings at laparoscopy were considered the reference standard. Patients were stratified according to their need for monodisciplinary surgical approach, carried out by gynecologists only, or multidisciplinary surgical approach, involving abdominal surgeons and/or urologists, based on the extent to which endometriosis affected the reproductive organs, bowel, ureters, bladder or other abdominal organs. RESULTS Our standard preoperative imaging approach and the combined findings of TVS and MRI had similar diagnostic performance, resulting in correct stratification for a monodisciplinary or a multidisciplinary surgical approach of 67/74 (90.5%) patients. However, there were differences between the estimation of the severity of disease by DCBE and MRI. The severity of rectal involvement was underestimated in 2.7% of the patients by both TVS and DCBE, whereas it was overestimated in 6.8% of the patients by TVS and/or DCBE. CONCLUSIONS Complementary to expert TVS, 'one-stop' MRI can predict intraoperative findings equally well as standard radiological imaging (IVU and DCBE) in patients referred for endometriosis surgery in a tertiary care academic center. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- D Bielen
- Department of Radiology, KU Leuven University Hospitals, Leuven, Belgium
- Department of Imaging and Pathology, KU Leuven University Hospitals, Leuven, Belgium
| | - C Tomassetti
- Leuven University Fertility Center, KU Leuven University Hospitals, Leuven, Belgium
- Department of Obstetrics and Gynecology, KU Leuven University Hospitals, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven University Hospitals, Leuven, Belgium
| | - D Van Schoubroeck
- Department of Obstetrics and Gynecology, KU Leuven University Hospitals, Leuven, Belgium
| | - D Vanbeckevoort
- Department of Radiology, KU Leuven University Hospitals, Leuven, Belgium
| | - L De Wever
- Department of Radiology, KU Leuven University Hospitals, Leuven, Belgium
| | - T Van den Bosch
- Department of Obstetrics and Gynecology, KU Leuven University Hospitals, Leuven, Belgium
| | - T D'Hooghe
- Leuven University Fertility Center, KU Leuven University Hospitals, Leuven, Belgium
- Global Medical Affairs Fertility, Merck Healthcare KGaA, Darmstadt, Germany
| | - T Bourne
- Department of Obstetrics and Gynecology, KU Leuven University Hospitals, Leuven, Belgium
- Department of Gynecology and Obstetrics, Imperial College Healthcare NHS Trust, London, UK
| | - A D'Hoore
- Department of Abdominal Surgery, KU Leuven University Hospitals, Leuven, Belgium
- Department of Oncology, KU Leuven University Hospitals, Leuven, Belgium
| | - A Wolthuis
- Department of Abdominal Surgery, KU Leuven University Hospitals, Leuven, Belgium
- Department of Oncology, KU Leuven University Hospitals, Leuven, Belgium
| | | | - C Meuleman
- Department of Obstetrics and Gynecology, KU Leuven University Hospitals, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven University Hospitals, Leuven, Belgium
- Leuven University Endometriosis Center, KU Leuven University Hospitals, Leuven, Belgium
| | - D Timmerman
- Department of Obstetrics and Gynecology, KU Leuven University Hospitals, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven University Hospitals, Leuven, Belgium
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Wild M, Pandhi S, Rendle J, Swift I, Ofuasia E. MRI for the diagnosis and staging of deeply infiltrating endometriosis: a national survey of BSGE accredited endometriosis centres and review of the literature. Br J Radiol 2020; 93:20200690. [PMID: 32706984 DOI: 10.1259/bjr.20200690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
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.
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Affiliation(s)
- Marianne Wild
- Department of Obstetrics and Gynaecology, Croydon University Hospital Endometriosis Centre 530 London Road , Croydon CR7 7YE, United Kingdom.,Department of Obstetrics and Gynaecology, Homerton University Hospital Endometriosis Centre Homerton Row , London E9 6DY, United Kingdom
| | - Shikha Pandhi
- Department of Radiology, Croydon University Hospital Endometriosis Centre 530 London Road, Croydon CR7 7YE, United Kingdom
| | - John Rendle
- Department of Radiology, Croydon University Hospital Endometriosis Centre 530 London Road, Croydon CR7 7YE, United Kingdom
| | - Ian Swift
- Department of Colorectal Surgery, Croydon University Hospital Endometriosis Centre 530 London Road , Croydon CR7 7YE, United Kingdom
| | - Emmanuel Ofuasia
- Department of Obstetrics and Gynaecology, Croydon University Hospital Endometriosis Centre 530 London Road , Croydon CR7 7YE, United Kingdom
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Prašnikar E, Knez J, Kovačič B, Kunej T. Molecular signature of eutopic endometrium in endometriosis based on the multi-omics integrative synthesis. J Assist Reprod Genet 2020; 37:1593-1611. [PMID: 32474803 PMCID: PMC7376782 DOI: 10.1007/s10815-020-01833-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 05/14/2020] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To synthesise data from genome-wide studies reporting molecular signature of eutopic endometrium through the phases of the menstrual cycle in endometriosis. METHODS Extraction of data from publications reporting genetic signatures characterising endometrium associated with endometriosis. The nomenclature of extracted differentially expressed transcripts and proteins was adopted according to the HUGO Gene Nomenclature Committee (HGNC). Loci were further sorted according to the different phases of the menstrual cycle, i.e. menstrual (M), proliferative (P), secretory (S), early-secretory (ES), mid-secretory (MS), late-secretory (LS), and not specified (N/S) if the endometrial dating was not available. Enrichment analysis was performed using the DAVID bioinformatics tool. RESULTS Altered molecular changes were reported by 21 studies, including 13 performed at the transcriptomic, 6 at proteomic, and 2 at epigenomic level. Extracted data resulted in a catalogue of total 670 genetic causes with available 591 official gene symbols, i.e. M = 3, P = 188, S = 81, ES = 82, MS = 173, LS = 36, and N/S = 28. Enriched pathways included oestrogen signalling pathway, extracellular matrix organization, and endothelial cell chemotaxis. Our study revealed that knowledge of endometrium biology in endometriosis is fragmented due to heterogeneity of published data. However, 15 genes reported as dysregulated by at least two studies within the same phase and 33 significantly enriched GO-BP terms/KEGG pathways associated with different phases of the menstrual cycle were identified. CONCLUSIONS A multi-omics insight into molecular patterns underlying endometriosis could contribute towards identification of endometrial pathological mechanisms that impact fertility capacities of women with endometriosis.
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Affiliation(s)
- Erika Prašnikar
- Department of Reproductive Medicine and Gynecological Endocrinology, University Medical Centre Maribor, 2000, Maribor, Slovenia
| | - Jure Knez
- Department of Gynecological and Breast Oncology, University Medical Centre Maribor, 2000, Maribor, Slovenia
| | - Borut Kovačič
- Department of Reproductive Medicine and Gynecological Endocrinology, University Medical Centre Maribor, 2000, Maribor, Slovenia.
| | - Tanja Kunej
- Biotechnical Faculty, Department of Animal Science, University of Ljubljana, 1000, Ljubljana, Slovenia.
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Mason BR, Chatterjee D, Menias CO, Thaker PH, Siegel CL, Yano M. Encyclopedia of endometriosis: a pictorial rad-path review. Abdom Radiol (NY) 2020; 45:1587-1607. [PMID: 31919647 DOI: 10.1007/s00261-019-02381-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Endometriosis affects approximately 10% of reproductive age women and represents a significant cause of pelvic pain and infertility. Unfortunately, the diagnosis of endometriosis is often delayed by years. Endometriosis may manifest as cystic lesions in the ovaries known as endometriomas. Superficial endometriosis is typically detected by laparoscopy along the pelvic peritoneum as these lesions tend to be difficult to detect by imaging. Deep infiltrative endometriosis may be detected by ultrasound, CT or MRI in classic locations within the pelvis, such as the posterior cul-de-sac and uterosacral ligaments. Endometriosis may also involve the thorax, gastrointestinal and urinary tracts, and locations such as the abdominal wall and abdominal organs. We present MRI and CT case examples, together with corresponding laparoscopic and histopathology images to enhance radiologists' understanding of this disease.
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Affiliation(s)
- Brandon R Mason
- Department of Radiology, Stillwater Medical Center, Stillwater, OK, USA
| | - Deyali Chatterjee
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Premal H Thaker
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - Cary Lynn Siegel
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd., Campus Box 8131, St. Louis, MO, 63110, USA
| | - Motoyo Yano
- Department of Radiology, Mayo Clinic, Phoenix, AZ, USA.
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Nougaret S, Nikolovski I, Paroder V, Vargas HA, Sala E, Carrere S, Tetreau R, Hoeffel C, Forstner R, Lakhman Y. MRI of Tumors and Tumor Mimics in the Female Pelvis: Anatomic Pelvic Space-based Approach. Radiographics 2020; 39:1205-1229. [PMID: 31283453 DOI: 10.1148/rg.2019180173] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Pelvic masses can present a diagnostic challenge owing to the difficulty in assessing their origin and the overlap in imaging features. The majority of pelvic tumors arise from gastrointestinal or genitourinary organs, with less common sites of origin including the connective tissues, nerves, and lymphovascular structures. Lesion evaluation usually starts with clinical assessment followed by imaging, or the lesion may be an incidental finding at imaging performed for other clinical indications. Since accurate diagnosis is essential for optimal management, imaging is useful for suggesting the correct diagnosis or narrowing the differential possibilities and distinguishing tumors from their mimics. Some masses may require histologic confirmation of the diagnosis with biopsy and/or up-front surgical resection. In this case, imaging is essential for presurgical planning to assess mass size and location, evaluate the relationship to adjacent pelvic structures, and narrow differential possibilities. Pelvic US is often the first imaging modality performed in women with pelvic symptoms. While US is often useful to detect a pelvic mass, it has significant limitations in assessing masses located deep in the pelvis or near gas-filled organs. CT also has limited value in the pelvis owing to its inferior soft-tissue contrast. MRI is frequently the optimal imaging modality, as it offers both multiplanar capability and excellent soft-tissue contrast. This article highlights the normal anatomy of the pelvic spaces in the female pelvis and focuses on MRI features of common tumors and tumor mimics that arise in these spaces. It provides an interpretative algorithm for approaching an unknown pelvic lesion at MRI. It also discusses surgical management, emphasizing the value of MRI as a road map to surgery and highlighting anatomic locations where surgical resection may present a challenge. ©RSNA, 2019.
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Affiliation(s)
- Stephanie Nougaret
- From the Montpellier Cancer Research Institute (IRCM), INSERM U1194, Montpellier, France (S.N.); Departments of Radiology (S.N., R.T.) and Surgery (S.C.), Montpellier Cancer Institute, University of Montpellier, 208 Ave des Apothicaires, Montpellier 34298, France; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (I.N., V.P., H.A.V., Y.L.); Department of Radiology, Cambridge Biomedical Campus, Cambridge, England (E.S.); Department of Radiology, CHU Reims, Reims, France (C.H.); CReSTIC, URCA, Reims University, Reims, France (C.H.); and Department of Radiology, Universitätsklinikum, PMU, Salzburg, Austria (R.F.)
| | - Ines Nikolovski
- From the Montpellier Cancer Research Institute (IRCM), INSERM U1194, Montpellier, France (S.N.); Departments of Radiology (S.N., R.T.) and Surgery (S.C.), Montpellier Cancer Institute, University of Montpellier, 208 Ave des Apothicaires, Montpellier 34298, France; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (I.N., V.P., H.A.V., Y.L.); Department of Radiology, Cambridge Biomedical Campus, Cambridge, England (E.S.); Department of Radiology, CHU Reims, Reims, France (C.H.); CReSTIC, URCA, Reims University, Reims, France (C.H.); and Department of Radiology, Universitätsklinikum, PMU, Salzburg, Austria (R.F.)
| | - Viktoriya Paroder
- From the Montpellier Cancer Research Institute (IRCM), INSERM U1194, Montpellier, France (S.N.); Departments of Radiology (S.N., R.T.) and Surgery (S.C.), Montpellier Cancer Institute, University of Montpellier, 208 Ave des Apothicaires, Montpellier 34298, France; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (I.N., V.P., H.A.V., Y.L.); Department of Radiology, Cambridge Biomedical Campus, Cambridge, England (E.S.); Department of Radiology, CHU Reims, Reims, France (C.H.); CReSTIC, URCA, Reims University, Reims, France (C.H.); and Department of Radiology, Universitätsklinikum, PMU, Salzburg, Austria (R.F.)
| | - Hebert A Vargas
- From the Montpellier Cancer Research Institute (IRCM), INSERM U1194, Montpellier, France (S.N.); Departments of Radiology (S.N., R.T.) and Surgery (S.C.), Montpellier Cancer Institute, University of Montpellier, 208 Ave des Apothicaires, Montpellier 34298, France; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (I.N., V.P., H.A.V., Y.L.); Department of Radiology, Cambridge Biomedical Campus, Cambridge, England (E.S.); Department of Radiology, CHU Reims, Reims, France (C.H.); CReSTIC, URCA, Reims University, Reims, France (C.H.); and Department of Radiology, Universitätsklinikum, PMU, Salzburg, Austria (R.F.)
| | - Evis Sala
- From the Montpellier Cancer Research Institute (IRCM), INSERM U1194, Montpellier, France (S.N.); Departments of Radiology (S.N., R.T.) and Surgery (S.C.), Montpellier Cancer Institute, University of Montpellier, 208 Ave des Apothicaires, Montpellier 34298, France; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (I.N., V.P., H.A.V., Y.L.); Department of Radiology, Cambridge Biomedical Campus, Cambridge, England (E.S.); Department of Radiology, CHU Reims, Reims, France (C.H.); CReSTIC, URCA, Reims University, Reims, France (C.H.); and Department of Radiology, Universitätsklinikum, PMU, Salzburg, Austria (R.F.)
| | - Sebastien Carrere
- From the Montpellier Cancer Research Institute (IRCM), INSERM U1194, Montpellier, France (S.N.); Departments of Radiology (S.N., R.T.) and Surgery (S.C.), Montpellier Cancer Institute, University of Montpellier, 208 Ave des Apothicaires, Montpellier 34298, France; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (I.N., V.P., H.A.V., Y.L.); Department of Radiology, Cambridge Biomedical Campus, Cambridge, England (E.S.); Department of Radiology, CHU Reims, Reims, France (C.H.); CReSTIC, URCA, Reims University, Reims, France (C.H.); and Department of Radiology, Universitätsklinikum, PMU, Salzburg, Austria (R.F.)
| | - Raphael Tetreau
- From the Montpellier Cancer Research Institute (IRCM), INSERM U1194, Montpellier, France (S.N.); Departments of Radiology (S.N., R.T.) and Surgery (S.C.), Montpellier Cancer Institute, University of Montpellier, 208 Ave des Apothicaires, Montpellier 34298, France; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (I.N., V.P., H.A.V., Y.L.); Department of Radiology, Cambridge Biomedical Campus, Cambridge, England (E.S.); Department of Radiology, CHU Reims, Reims, France (C.H.); CReSTIC, URCA, Reims University, Reims, France (C.H.); and Department of Radiology, Universitätsklinikum, PMU, Salzburg, Austria (R.F.)
| | - Christine Hoeffel
- From the Montpellier Cancer Research Institute (IRCM), INSERM U1194, Montpellier, France (S.N.); Departments of Radiology (S.N., R.T.) and Surgery (S.C.), Montpellier Cancer Institute, University of Montpellier, 208 Ave des Apothicaires, Montpellier 34298, France; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (I.N., V.P., H.A.V., Y.L.); Department of Radiology, Cambridge Biomedical Campus, Cambridge, England (E.S.); Department of Radiology, CHU Reims, Reims, France (C.H.); CReSTIC, URCA, Reims University, Reims, France (C.H.); and Department of Radiology, Universitätsklinikum, PMU, Salzburg, Austria (R.F.)
| | - Rosemarie Forstner
- From the Montpellier Cancer Research Institute (IRCM), INSERM U1194, Montpellier, France (S.N.); Departments of Radiology (S.N., R.T.) and Surgery (S.C.), Montpellier Cancer Institute, University of Montpellier, 208 Ave des Apothicaires, Montpellier 34298, France; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (I.N., V.P., H.A.V., Y.L.); Department of Radiology, Cambridge Biomedical Campus, Cambridge, England (E.S.); Department of Radiology, CHU Reims, Reims, France (C.H.); CReSTIC, URCA, Reims University, Reims, France (C.H.); and Department of Radiology, Universitätsklinikum, PMU, Salzburg, Austria (R.F.)
| | - Yulia Lakhman
- From the Montpellier Cancer Research Institute (IRCM), INSERM U1194, Montpellier, France (S.N.); Departments of Radiology (S.N., R.T.) and Surgery (S.C.), Montpellier Cancer Institute, University of Montpellier, 208 Ave des Apothicaires, Montpellier 34298, France; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (I.N., V.P., H.A.V., Y.L.); Department of Radiology, Cambridge Biomedical Campus, Cambridge, England (E.S.); Department of Radiology, CHU Reims, Reims, France (C.H.); CReSTIC, URCA, Reims University, Reims, France (C.H.); and Department of Radiology, Universitätsklinikum, PMU, Salzburg, Austria (R.F.)
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Collins BG, Ankola A, Gola S, McGillen KL. Transvaginal US of Endometriosis: Looking Beyond the Endometrioma with a Dedicated Protocol. Radiographics 2020; 39:1549-1568. [PMID: 31498746 DOI: 10.1148/rg.2019190045] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Transvaginal sonography (TVS) is a valuable primary imaging tool for the initial evaluation and management of endometriosis, a complex multifocal disease process with a varied spectrum of clinical and morphologic features that can substantially affect quality of life. The high accuracy of TVS for the detailed mapping of disease extent, an essential process for guiding treatment strategies, is well documented. The dynamic nature of US provides added value, revealing information that is not easily addressed with other imaging modalities. As recognized by the International Deep Endometriosis Analysis Consensus Group, a dedicated standardized protocol that is used by experienced and knowledgeable operators is necessary for a complete evaluation. The four components of a dedicated TVS protocol for evaluation of pelvic endometriosis are (a) evaluation of the uterus and adnexa, (b) dedicated search for deep infiltrating endometriosis, (c) assessment of the sliding sign, and (d) detection of sonographic soft markers. These components are described, and the multiple locations and US findings of endometriosis within the pelvis are reviewed, with emphasis on the unique features of US as an extension of the physical examination. In addition to enabling evaluation of the static findings of adenomyosis, endometrioma, hydrosalpinx, hematosalpinx, and hypoechoic nodules of deep infiltrating endometriosis, dynamic TVS enables assessment of pouch of Douglas obliteration, organ mobility, and site-specific tenderness, as well as tenderness-guided imaging. The benefits of implementing a dedicated TVS protocol in terms of improved patient care are also discussed. Online supplemental material is available for this article. ©RSNA, 2019.
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Affiliation(s)
- Belinda G Collins
- From the Department of Radiology, Penn State Health Milton S. Hershey Medical Center, Pennsylvania State College of Medicine, 500 University Dr, Hershey, PA 17033-0850 (B.G.C., S.G., K.L.M.); and Department of Radiology, University of Florida College of Medicine, Jacksonville, Fla (A.A.)
| | - Anita Ankola
- From the Department of Radiology, Penn State Health Milton S. Hershey Medical Center, Pennsylvania State College of Medicine, 500 University Dr, Hershey, PA 17033-0850 (B.G.C., S.G., K.L.M.); and Department of Radiology, University of Florida College of Medicine, Jacksonville, Fla (A.A.)
| | - Sparsh Gola
- From the Department of Radiology, Penn State Health Milton S. Hershey Medical Center, Pennsylvania State College of Medicine, 500 University Dr, Hershey, PA 17033-0850 (B.G.C., S.G., K.L.M.); and Department of Radiology, University of Florida College of Medicine, Jacksonville, Fla (A.A.)
| | - Kathryn L McGillen
- From the Department of Radiology, Penn State Health Milton S. Hershey Medical Center, Pennsylvania State College of Medicine, 500 University Dr, Hershey, PA 17033-0850 (B.G.C., S.G., K.L.M.); and Department of Radiology, University of Florida College of Medicine, Jacksonville, Fla (A.A.)
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Jena SK, Begum J, Kumari S, Kar C. The Groin Endometriosis: A Great Mimicker of Common Groin Conditions. J Gynecol Surg 2020. [DOI: 10.1089/gyn.2019.0090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Saubhagya Kumar Jena
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Jasmina Begum
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Supriya Kumari
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Chinmayee Kar
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Bhubaneswar, India
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Rangunwala J, Sitta J, Vyas K, Roda M. Multimodality Thoracoabdominal Imaging Findings in a Rare Case of Thoracic Endometriosis Syndrome. Cureus 2020; 12:e6819. [PMID: 32181066 PMCID: PMC7051114 DOI: 10.7759/cureus.6819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Thoracic endometriosis syndrome (TES) is an extremely rare disorder, and it is defined as the presence of functional endometrial tissue in pleura, airways, and lung parenchyma. We describe a rare case of a 29-year-old nulliparous female who presented with abdominal pain, dyspareunia, and shortness of breath. She complained of worsening of symptoms around the menstrual cycle. Initial workup showed markedly elevated CA-125 levels. A chest radiograph and CT of the chest, abdomen, and pelvis demonstrated large tension hydrothorax, ascites, and bilateral ovarian cysts. A chest tube was placed to decompress the tension hydrothorax, which drained copious amounts of blood. In view of the unexplained etiology of large hemothorax and elevated CA-125 levels, an MRI of the abdomen and pelvis was performed. This revealed advanced pelvic endometriosis, a right pleural nodule, and ipsilateral hydropneumothorax. Based on these findings, a diagnosis of TES was presumed. The patient was then referred to video-assisted thoracoscopy (VATS) and continuous estrogen suppression for optimal treatment. On early follow-up, she presented with recurrent hydropneumothorax, which was successfully managed with CT-guided chest tube placement and remained stable on further follow-ups. TES diagnosis is often challenging and delayed, demanding a high index of suspicion in patients with risk factors and characteristic clinical presentation. Radiologists should be aware of key imaging findings to help in early diagnosis for timely clinical and surgical management.
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Affiliation(s)
| | - Juliana Sitta
- Radiology, University of Mississippi Medical Center, Jackson, USA
| | - Kshama Vyas
- Family Medicine, University of Mississippi Medical Center, Jackson, USA
| | - Manohar Roda
- Radiology, University of Mississippi Medical Center, Jackson, USA
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Tran-Harding K, Nair RT, Dawkins A, Ayoob A, Owen J, Deraney S, Lee JT, Stevens S, Ganesh H. Endometriosis revisited: an imaging review of the usual and unusual manifestations with pathological correlation. Clin Imaging 2018; 52:163-171. [DOI: 10.1016/j.clinimag.2018.07.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/10/2018] [Accepted: 07/23/2018] [Indexed: 01/06/2023]
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Espada M, Alvarez-Moreno E, Jimenez de la Pena M, Munoz Capio V, Reid S, Condous G. Imaging techniques in endometriosis. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2018. [DOI: 10.1177/2284026518773215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Endometriosis is a common gynecological condition affecting up to 15% of the general female population. Here, we present a systematic review of imaging techniques of endometriosis. The aim of this review is to determine the most accurate site-specific preoperative diagnostic tools in order to map, locate, evaluate the extension, and stage the disease. There are important reasons to stage endometriosis: to create a common language, to enable specificity of diagnosis, standardize comparisons, and to facilitate research applications. The requirements of an ideal endometriosis classification system are that it be empirically and scientifically based, be of general consensus, have unambiguous definition of terms, be comprehensive in all cases, have a simple translation from anatomic features to verbal description, reflect disease, predict fertility, predict pain relief, be useful to guide treatment, indicate risk of recurrence, identify clinical situations in which it does not apply, be simple to calculate, and be easy to communicate to women. An extensive search of papers regarding imaging techniques in endometriosis was performed in Pubmed from January 1992 to February 2018, including original peer-reviewed papers, reviews, and international guidelines.
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Affiliation(s)
- Mercedes Espada
- Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Sydney Medical School Nepean, Nepean Hospital, The University of Sydney, Penrith, NSW, Australia
| | | | | | | | - Shannon Reid
- Department of Obstetrics and Gynaecology, Wollongong Hospital, Wollongong, NSW, Australia
| | - George Condous
- Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Sydney Medical School Nepean, Nepean Hospital, The University of Sydney, Penrith, NSW, Australia
- OMNI Ultrasound & Gynaecological Care, Centre for Women’s Ultrasound and Early Pregnancy, Sydney, NSW, Australia
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Abstract
Although common nonspecific symptoms (i.e., rectal bleeding, pelvic pressure, and change in bowel habits) are associated with rectal cancer, occasionally these are related to a different underlying disease. Over the past few years, considerable progress has been made in imaging of the rectum. Specifically, new magnetic resonance techniques and capabilities provide impressive high-resolution assessment of the rectal wall and enable evaluation and characterization of the perirectal tissues. This paper reviews imaging findings of uncommon causes of rectal and perirectal pathology that may be clinically confounded with rectal cancer. Radiologists need to be aware of uncommon pathologies in this region in order to facilitate optimal management decisions.
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Foti PV, Farina R, Palmucci S, Vizzini IAA, Libertini N, Coronella M, Spadola S, Caltabiano R, Iraci M, Basile A, Milone P, Cianci A, Ettorre GC. Endometriosis: clinical features, MR imaging findings and pathologic correlation. Insights Imaging 2018; 9:149-172. [PMID: 29450853 PMCID: PMC5893487 DOI: 10.1007/s13244-017-0591-0] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 12/11/2017] [Accepted: 12/27/2017] [Indexed: 12/23/2022] Open
Abstract
Objective We illustrate the magnetic resonance imaging (MRI) features of endometriosis. Background Endometriosis is a chronic gynaecological condition affecting women of reproductive age and may cause pelvic pain and infertility. It is characterized by the growth of functional ectopic endometrial glands and stroma outside the uterus and includes three different manifestations: ovarian endometriomas, peritoneal implants, deep pelvic endometriosis. The primary locations are in the pelvis; extrapelvic endometriosis may rarely occur. Diagnosis requires a combination of clinical history, invasive and non-invasive techniques. The definitive diagnosis is based on laparoscopy with histological confirmation. Diagnostic imaging is necessary for treatment planning. MRI is as a second-line technique after ultrasound. The MRI appearance of endometriotic lesions is variable and depends on the quantity and age of haemorrhage, the amount of endometrial cells, stroma, smooth muscle proliferation and fibrosis. The purpose of surgery is to achieve complete resection of all endometriotic lesions in the same operation. Conclusion Owing to the possibility to perform a complete assessment of all pelvic compartments at one time, MRI represents the best imaging technique for preoperative staging of endometriosis, in order to choose the more appropriate surgical approach and to plan a multidisciplinary team work. Teaching Points • Endometriosis includes ovarian endometriomas, peritoneal implants and deep pelvic endometriosis. • MRI is a second-line imaging technique after US. • Deep pelvic endometriosis is associated with chronic pelvic pain and infertility. • Endometriosis is characterized by considerable diagnostic delay. • MRI is the best imaging technique for preoperative staging of endometriosis.
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Affiliation(s)
- Pietro Valerio Foti
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy.
| | - Renato Farina
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Stefano Palmucci
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Ilenia Anna Agata Vizzini
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Norma Libertini
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Maria Coronella
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Saveria Spadola
- Department G.F. Ingrassia - Institute of Pathology, University of Catania, Catania, Italy
| | - Rosario Caltabiano
- Department G.F. Ingrassia - Institute of Pathology, University of Catania, Catania, Italy
| | - Marco Iraci
- Department of General Surgery and Medical-Surgical Specialties - Institute of Obstetrics and Ginecology, University of Catania, Catania, Italy
| | - Antonio Basile
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Pietro Milone
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
| | - Antonio Cianci
- Department of General Surgery and Medical-Surgical Specialties - Institute of Obstetrics and Ginecology, University of Catania, Catania, Italy
| | - Giovanni Carlo Ettorre
- Radiodiagnostic and Radiotherapy Unit, University Hospital "Policlinico-Vittorio Emanuele", Via Santa Sofia 78, 95123, Catania, Italy
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Van den Bosch T, Van Schoubroeck D. Ultrasound diagnosis of endometriosis and adenomyosis: State of the art. Best Pract Res Clin Obstet Gynaecol 2018; 51:16-24. [PMID: 29506961 DOI: 10.1016/j.bpobgyn.2018.01.013] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 01/23/2018] [Indexed: 11/18/2022]
Abstract
Transvaginal ultrasonography has become the primary test in the diagnosis of pelvic endometriosis and adenomyosis. A review of the literature on the diagnostic accuracy of ultrasonography in pelvic endometriosis and adenomyosis, as well as a comparison with magnetic resonance imaging, will be presented. Criteria for diagnosis of an endometrioma according to robust prospective data together with guidelines as to adequate reporting of the location of deep infiltrating endometriosis will be given. The sonographic features of adenomyosis including the differential diagnosis between focal adenomyosis and a uterine fibroid are reviewed. The available data in the literature on ultrasound diagnosis of pelvic endometriosis and adenomyosis, their clinical relevance, and their limitations are discussed.
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Affiliation(s)
- Thierry Van den Bosch
- Department of Obstetrics and Gynecology, University Hospital K.U. Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - Dominique Van Schoubroeck
- Department of Obstetrics and Gynecology, University Hospital K.U. Leuven, Herestraat 49, 3000, Leuven, Belgium.
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Nasser H, King M, Rosenberg HK, Rosen A, Wilck E, Simpson WL. Anatomy and pathology of the canal of Nuck. Clin Imaging 2018; 51:83-92. [PMID: 29448124 DOI: 10.1016/j.clinimag.2018.02.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 01/17/2018] [Accepted: 02/02/2018] [Indexed: 11/26/2022]
Abstract
The canal of Nuck is the female equivalent of the processus vaginalis in the male but is less well known than its male counterpart. It is a rare entity not commonly encountered by radiologists, particularly in the adult population. Knowledge of the embryology and anatomy of the canal of Nuck is essential for identification of the various pathologic conditions that may occur in this location. Moreover, radiologists should be familiar with this entity to compose an appropriate and thorough differential diagnosis of a labial mass/swelling. In this review, we discuss both the anatomy and the more common pathology that can be encountered within it.
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Affiliation(s)
- Hussein Nasser
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | - Michael King
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | | | - Ally Rosen
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | - Eric Wilck
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | - William L Simpson
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
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40
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Bazot M, Bharwani N, Huchon C, Kinkel-Trugli K, Cunha TM, Guerra A, Manganaro L, Bunesch L, Kido A, Togashi K, Thomassin-Naggara I, Rockall A. Recommandations de la Société européenne d’imagerie génito-urinaire : IRM de l’endométriose pelvienne. IMAGERIE DE LA FEMME 2017. [DOI: 10.1016/j.femme.2017.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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41
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Suchońska B, Gajewska M, Zyguła A, Wielgoś M. Endometriosis resembling endometrial cancer in a postmenopausal patient. Climacteric 2017; 21:88-91. [PMID: 29166801 DOI: 10.1080/13697137.2017.1398229] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Endometriosis occurs in 2-4% of postmenopausal women. There have been a few reports of endometriosis in women in whom neither history nor diagnostic imaging indicated the presence of this disease, either at reproductive age or after menopause. A case is described of an 84-year-old patient with extensive deep pelvic endometriosis imitating advanced neoplastic process.
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Affiliation(s)
- B Suchońska
- a 1st Department of Obstetrics and Gynecology , Warsaw Medical University , Warsaw , Poland
| | - M Gajewska
- a 1st Department of Obstetrics and Gynecology , Warsaw Medical University , Warsaw , Poland
| | - A Zyguła
- a 1st Department of Obstetrics and Gynecology , Warsaw Medical University , Warsaw , Poland
| | - M Wielgoś
- a 1st Department of Obstetrics and Gynecology , Warsaw Medical University , Warsaw , Poland
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42
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Kyuragi Y, Nishie A, Takayama Y, Asayama Y, Ishigami K, Ueki T, Hirahashi M, Honda H. Mass-forming Retroperitoneal Endometriosis Including a Fat Component: A Diagnostic Dilemma. Magn Reson Med Sci 2017; 16:181-182. [PMID: 28003619 PMCID: PMC5600023 DOI: 10.2463/mrms.ci.2016-0078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | - Hiroshi Honda
- Departments of Clinical Radiology, Kyushu University
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43
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Management of Endometriomas Prior to IVF. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2017. [DOI: 10.5301/jeppd.5000292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Endometriosis causes a decrease in fertility in affected patients. The different forms of the disease, peritoneal, ovarian, deep infiltrating and adenomyosis, are often present in varying degrees in the same patient, either together or individually, and cause infertility through a pathogenesis that is not yet clear. A significant number of women with endometriosis and endometriomas will eventually seek assisted reproductive technology (ART) for conception. The specific impact of endometriomas alone and the impact of surgical intervention for endometriomas on the reproductive outcome of women undergoing in vitro fertilization/intra-cytoplasmic sperm injection (IVF/ICSI) are areas that need further clarification and, for this reason, the management of endometriomas before clinical IVF is a very complex topic. In order to provide useful information for the clinical management of patients with endometriomas having IVF, in this review we investigated: the impact of the presence of endometriomas, both individually and associated with other types of the disease, on IVF techniques; the possible role of surgery and its possible negative effects; the risks and difficulties related to conservative management during IVF procedures.
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44
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Bazot M, Bharwani N, Huchon C, Kinkel K, Cunha TM, Guerra A, Manganaro L, Buñesch L, Kido A, Togashi K, Thomassin-Naggara I, Rockall AG. European society of urogenital radiology (ESUR) guidelines: MR imaging of pelvic endometriosis. Eur Radiol 2017; 27:2765-2775. [PMID: 27921160 PMCID: PMC5486785 DOI: 10.1007/s00330-016-4673-z] [Citation(s) in RCA: 184] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 10/05/2016] [Accepted: 11/23/2016] [Indexed: 12/21/2022]
Abstract
Endometriosis is a common gynaecological condition of unknown aetiology that primarily affects women of reproductive age. The accepted first-line imaging modality is pelvic ultrasound. However, magnetic resonance imaging (MRI) is increasingly performed as an additional investigation in complex cases and for surgical planning. There is currently no international consensus regarding patient preparation, MRI protocols or reporting criteria. Our aim was to develop clinical guidelines for MRI evaluation of pelvic endometriosis based on literature evidence and consensus expert opinion. This work was performed by a group of radiologists from the European Society of Urogenital Radiology (ESUR), experts in gynaecological imaging and a gynaecologist expert in methodology. The group discussed indications for MRI, technical requirements, patient preparation, MRI protocols and criteria for the diagnosis of pelvic endometriosis on MRI. The expert panel proposed a final recommendation for each criterion using Oxford Centre for Evidence Based Medicine (OCEBM) 2011 levels of evidence. KEY POINTS • This report provides guidelines for MRI in endometriosis. • Minimal and optimal MRI acquisition protocols are provided. • Recommendations are proposed for patient preparation, best MRI sequences and reporting criteria.
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Affiliation(s)
- M. Bazot
- Department of Radiology, Tenon Hospital, 58 Avenue Gambetta, Paris, 75020 France
| | - N. Bharwani
- Department of Radiology, St Mary’s Hospital, Imperial College Healthcare NHS Trust, 3rd Floor Queen Elizabeth the Queen Mother Building, Praed Street, London, W2 1NY UK
| | - C. Huchon
- Department of Obtetrics and Gynaecology, CHI Poissy Saint-Germain en Laye,Versailles University France, 10 rue du champ Gaillard, 78300 Poissy, France
| | - K. Kinkel
- Institut de radiologie, Clinique des Grangettes, 7, chemin des Grangettes, CH 1224 Chêne-Bougeries, Switzerland
| | - T. M. Cunha
- Serviço de Radiologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Rua Prof. Lima Basto, 1099-023 Lisboa, Portugal
| | - A. Guerra
- Department of Radiology, Hospital da Luz, Lisbon, Portugal
| | - L. Manganaro
- Department of Radiological Sciences, Sapienza University of Rome, Vle. Regina Elena 324, 00162 Rome, Italy
| | - L. Buñesch
- Department of Radiology (Urogenital Section), Hospital Clínic Barcelona, Villarroel, 170, Barcelona, 08036 Spain
| | - A. Kido
- Department of Diagnostic Radiology, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507 Japan
| | - K. Togashi
- Department of Diagnostic Radiology, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507 Japan
| | - I. Thomassin-Naggara
- Department of Radiology, Tenon Hospital, 58 Avenue Gambetta, Paris, 75020 France
| | - A. G. Rockall
- Department of Radiology, The Royal Marsden Hospital, Fulham Road, London, SW3 6JJ UK
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45
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Abstract
Endometriosis is a common condition with significant morbidity, including pain and subfertility, which is often subject to a delay in diagnosis. Ultrasound has been successfully utilized, mostly outside North America, to preoperatively stage deep endometriosis, but in these international settings, imaging is typically performed solely by expert radiologists and gynecologists. We outline a method for detailed sonographic survey of the lower abdomen and pelvis to ensure optimum detection and communication of disease extent that is geared to radiologists practicing ultrasound in the United States, with the use of diagnostic medical sonographers.
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Abstract
Colorectal cancer is the third most commonly diagnosed cancer in men and second most commonly diagnosed cancer in women worldwide. Initial diagnosis of colorectal malignancy is generally made on colonoscopy, sigmoidoscopy or digital rectal examination; however, with increased use of CT as primary investigation in patients with lower gastrointestinal symptoms, the diagnosis of colon cancer is often first apparent to a radiologist prior to more invasive tests. CT can demonstrate a discrete soft-tissue mass that narrows the colonic lumen or focal nodular wall thickening/stricture and a variety of pericolonic changes. Pattern of wall thickening has been described as an aid to differential diagnosis; however, significant overlap remains between primary colonic tumor and non-colonic tumors or benign conditions. Imaging is non-specific, and appropriate clinical history, direct inspection, histological analysis, and sometimes discussion at MDT are essential for accurate diagnosis and treatment planning. In this article, we will review the imaging features of some of these benign and malignant mimics of colorectal cancer, with accompanying histology slides where appropriate.
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47
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Full-Thickness Excision versus Shaving by Laparoscopy for Intestinal Deep Infiltrating Endometriosis: Rationale and Potential Treatment Options. BIOMED RESEARCH INTERNATIONAL 2016; 2016:3617179. [PMID: 27579309 PMCID: PMC4989089 DOI: 10.1155/2016/3617179] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 04/08/2016] [Accepted: 07/18/2016] [Indexed: 01/16/2023]
Abstract
Endometriosis is defined as the presence of endometrial mucosa (glands and stroma) abnormally implanted in locations other than the uterine cavity. Deep infiltrating endometriosis (DIE) is considered the most aggressive presentation of the disease, penetrating more than 5 mm in affected tissues, and it is reported in approximately 20% of all women with endometriosis. DIE can cause a complete distortion of the pelvic anatomy and it mainly involves uterosacral ligaments, bladder, rectovaginal septum, rectum, and rectosigmoid colon. This review describes the state of the art in laparoscopic approach for DIE with a special interest in intestinal involvement, according to recent literature findings. Our attention has been focused particularly on full-thickness excision versus shaving technique in deep endometriosis intestinal involvement. Particularly, the aim of this paper is clarifying from the clinical and methodological points of view the best surgical treatment of deep intestinal endometriosis, since there is no standard of care in the literature and in different surgical settings. Indeed, this review tries to suggest when it is advisable to manage the full-thickness excision or the shaving technique, also analyzing perioperative management, main complications, and surgical outcomes.
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48
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MRI technique for the preoperative evaluation of deep infiltrating endometriosis: current status and protocol recommendation. Clin Radiol 2016; 71:179-94. [DOI: 10.1016/j.crad.2015.09.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 08/20/2015] [Accepted: 09/16/2015] [Indexed: 12/31/2022]
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49
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Menni K, Facchetti L, Cabassa P. Extragenital endometriosis: assessment with MR imaging. A pictorial review. Br J Radiol 2016; 89:20150672. [PMID: 26846303 DOI: 10.1259/bjr.20150672] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Endometriosis is a gynaecologic disease characterized by endometrial tissue outside the uterine cavity. Commonly it affects the pelvic organs. When endometrial nodules or plaques are localized in sites other than the uterus or ovaries, it is termed extragenital endometriosis. Adequate pre-operative assessment is essential for treatment planning. MRI is a non-invasive method with high spatial resolution that allows the multiplanar evaluation of genital and extragenital endometriosis. Herein, we present a pictorial review of a variety of extragenital endometriosis cases, all of which can be encountered in clinical practice.
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Affiliation(s)
- Katiuscia Menni
- 1 Department of Radiology, Chiari General Hospital, Chiari (BS), Italy
| | - Luca Facchetti
- 2 Department of Radiology, University of Brescia, Brescia, Italy
| | - Paolo Cabassa
- 1 Department of Radiology, Chiari General Hospital, Chiari (BS), Italy
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50
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Assessment of pelvic floor muscles in women with deep endometriosis. Arch Gynecol Obstet 2016; 294:519-23. [DOI: 10.1007/s00404-016-4025-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 01/15/2016] [Indexed: 10/22/2022]
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