Endometriosis is a common, chronic, and often debilitating condition that affects women of reproductive age. It involves the growth of endometrial tissue outside the uterus, leading to a series of symptoms such as intense and progressive pain during the menstrual period (dysmenorrhea), pain during sexual intercourse (dyspareunia), changes in bowel or urinary habits during the menstrual period, pelvic pain chronic and infertility. Today, MRI with a protocol for mapping endometriosis foci has become a crucial diagnostic tool for evaluating the extent of this condition and therapeutic planning. This article provides an in-depth exploration of the role and importance of MRI in diagnosing and treating endometriosis.
What is Endometriosis?
Endometriosis is characterized by the presence of endometrial-like tissues outside the uterus. This abnormal growth can manifest in three ways: superficial (peritoneal) disease, ovarian disease (endometriomas), and deep endometriosis. The condition is often associated with adenomyosis, where endometrial tissue is confined to the uterine musculature.
The size of the endometriotic implants varies, ranging from microscopic implants to large cysts and nodules. Deep infiltrating endometriosis, which penetrates at least 5 mm into the retroperitoneal space or the pelvic organ wall, is particularly complex and surgically challenging.
Read More: What is Endometriosis?
Understanding the Role of MRI in Diagnosing Endometriosis
Magnetic resonance imaging (MRI) is a non-invasive diagnostic tool that uses magnetic fields generated by proton nuclei, mainly hydrogen, generating a signal that is captured and transformed into detailed images of the body’s internal structures. In the context of endometriosis, MRI provides a comprehensive view of the pelvic anatomy, helping to identify the presence and extent of endometriotic implants.
Although laparoscopy has long been considered the gold standard for diagnosing endometriosis, the potential risks associated with the procedure and its inability to effectively evaluate extraperitoneal structures have led to the increasing use of imaging techniques such as MRI. The high sensitivity and specificity of MRI make it a reliable tool for diagnosing endometriosis, particularly deep infiltrating endometriosis (DIE), endometrioma, as well as the adhesion process determined by the disease.
Read More: What are the treatment options for Endometriosis?
What are the main findings and why should MRI endometriosis mapping be performed?
MRI is a non-invasive method that generates high-resolution images of pelvic anatomy and pathologies.
This imaging method presents high sensitivity and specificity for the investigation of deep pelvic endometriosis (endometriotic implants that penetrate > 5 mm into the peritoneum of the pelvic structures) which can affect the rectosigmoid, bladder, nerves, vascular structures, ligaments, parametrium, vagina and the reproductive organs.
Furthermore, MRI is the method of choice for researching endometriosis cysts called endometriomas that can affect the appendages, especially the ovaries.
With this diagnostic method, we can also identify direct and indirect signs of pelvic adhesions and fibrosis, arising from the chronic inflammatory reaction caused by endometriosis or other diseases, which can cause pain and infertility.
It should not be forgotten that MRI contributes to the diagnosis of pathologies frequently associated with endometriosis, such as adenomyosis, myomatosis, hydrosalpinx, among others.
MRI also offers the possibility of assessing extrapelvic sites of endometriosis, such as the diaphragm, abdominal wall, and right iliac fossa (cecum, cecal appendix, and ileum).
On the other hand, imaging methods have low sensitivity for detecting endometriosis in its superficial form (small foci of endometriosis that do not penetrate > 5 mm into the peritoneum of pelvic structures). For this reason, a normal exam does not exclude the possibility of endometriosis, especially in symptomatic patients.
Carrying out endometriosis mapping using imaging methods, including MRI with an appropriate protocol and an expert radiologist, is of paramount importance to understand the extent and severity of the damage caused by the disease, appropriately program individualized treatment for each patient, appropriately plan the surgical procedure (which can be multidisciplinary) and anticipate the risks to the patient.
Preparing for an endometriosis MRI involves several steps:
Tell your doctor about any health conditions, allergies, recent surgeries, or metal implants, as these may affect the MRI procedure.
Address any fear of closed spaces, as this may make it difficult to perform the exam, making it necessary in some cases to sedate the patient.
Follow the doctor’s instructions regarding pre-procedure preparation, such as adequate fasting, partially full bladder, intestinal preparation, among others.
Remove all metallic objects (remember that MRI generates a magnetic field)
MRI Procedure: What to Expect
During the MRI procedure, the patient lies on their back on a table in front of the MRI machine. Ear protectors are provided to help cancel out the noise of the machine. The table then slides into the center of the ring-shaped MRI machine, and the scan begins.
The entire procedure is painless and typically takes around 30–50 minutes. The patient can communicate with the technician via an intercom during the scan.
Other Diagnostic Tools for Endometriosis
Although MRI is a valuable tool in diagnosing endometriosis, it is not the only method. Ultrasound with bowel preparation and laparoscopy are also frequently used.
Ultrasound with bowel preparation.
Ultrasonography uses sound waves to create images of internal organs, helping to identify pelvic anatomy and pathologies. Performing intestinal preparation in endometriosis mapping is essential for increasing the sensitivity of the diagnosis of deep endometriosis implants, especially intestinal ones, as it significantly reduces the presence of fecal residues and gas, which make it difficult to visualize the pelvic structures and their pathologies.
Laparoscopy
Laparoscopy remains the definitive method for diagnosing endometriosis despite the growing role of imaging techniques such as magnetic resonance imaging. It involves inserting a laparoscope (thin tube with a camera) through a small incision in the abdomen, allowing the surgeon to directly view the presence of endometrial growths.
Read more: Diagnostic imaging for Endometriosis
Conclusion:
In conclusion, endometriosis MRI plays a vital role in the diagnosis and treatment of endometriosis, a common but complex condition that mostly affects women of reproductive age. By providing detailed images of the pelvic anatomy, MRI allows the identification and evaluation of endometrial growths, helping to plan appropriate treatment strategies and minimizing risks to the patient.
References:
https://radiopaedia.org/articles/endometriosis?lang=us
https://insightsimaging.springeropen.com/articles/10.1186/s13244-021-01054-x