Structured Ultrasound and Magnetic Resonance Imaging Reports for Patients with Suspected Endometriosis: Guide for Imagers and Clinicians

doi:10.1016/j.jmig.2019.02.017

Journal of Minimally Invasive Gynecology

Volume 26, Issue 6, September–October 2019, Pages 1016-1025

https://doi.org/10.1016/j.jmig.2019.02.017 Get rights and content

Abstract

In this article we propose a structured imaging report applied to ultrasound and magnetic resonance imaging in patients with suspected endometriosis.

Section snippets

Methods

A group of clinicians, surgeons, and radiologists from a multicenter group in Sao Paulo, Brazil, the Mayo Clinic, Arizona, and the Cleveland Clinic, Ohio, were invited to provide their opinions given their expertise in imaging and management of patients with endometriosis.

Conclusion

Endometriosis is a complex disease in which a nonsurgical diagnosis may be challenging but feasible. For patients with endometriosis, management of symptoms requires a patient-centered approach and a multidisciplinary team for optimal outcomes. To minimize delay in diagnosis and provide appropriate treatment, the use of imaging modalities that accurately map disease involvement is critical. A complete pelvic imaging evaluation should be accompanied by a structured and informative report. This

References (27)

S Guerriero et al.
Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis, including terms, definitions and measurements: a consensus opinion from the International Deep Endometriosis Analysis (IDEA) group
Ultrasound Obstet Gynecol
(2016)
C Exacoustos et al.
Ultrasound mapping system for the surgical management of deep infiltrating endometriosis
Fertil Steril
(2014)
UA Menakaya et al.
Diagnostic laparoscopy in pre-surgical planning for higher stage endometriosis: is it still relevant?
Aust N Z J Obstet Gynaecol
(2016)
GA Dunselman et al.
ESHRE guideline: management of women with endometriosis
Hum Reprod
(2014)
MS Abrao et al.
Comparison between clinical examination, transvaginal sonography and magnetic resonance imaging for the diagnosis of deep endometriosis
Hum Reprod
(2007)
V Nisenblat et al.
Imaging modalities for the non-invasive diagnosis of endometriosis
Cochrane Database Syst Rev
(2016)
S Reid et al.
Can we improve the prediction of pouch of Douglas obliteration in women with suspected endometriosis using ultrasound-based models? A multicenter prospective observational study
Acta Obstet Gynaecol Scand
(2015)
SW Young et al.
Initial accuracy of and learning curve for transvaginal ultrasound with bowel preparation for deep endometriosis in a US tertiary care center
J Minim Invasive Gynecol
(2017)
X Zhang et al.
Evaluation of the sacral nerve plexus in pelvic endometriosis by three-dimensional MR neurography
J Magn Reson Imaging
(2017)
M Bazot et al.
European Society of Urogenital Radiology (ESUR) guidelines: MR imaging of pelvic endometriosis
Eur Radiol
(2017)

O Tuncyurek et al.

Structured versus narrative reporting of pelvic MRI in perianal fistulizing disease: impact on clarity, completeness, and surgical planning

Abdom Radiol (NY)

(2019)

MS Abrão et al.

Deep endometriosis infiltrating the recto-sigmoid: critical factors to consider before management

Hum Reprod Update

(2015)

C Chapron et al.

Surgery for bladder endometriosis: long-term results and concomitant management of associated posterior deep lesions

Hum Reprod

(2010)

Cited by (18)

Deep pelvic infiltrating endometriosis: MRI consensus lexicon and compartment-based approach from the ENDOVALIRM group
2023, Diagnostic and Interventional Imaging
The purpose of this consensus article was to develop guidelines by a focused panel of experts to elaborate a lexicon of image interpretation, and a standardized region-based reporting of deep infiltrating endometriosis (DIE) with magnetic resonance imaging (MRI).
Evidence-based data and expert opinion were combined using the RAND-UCLA Appropriateness Method to attain consensus guidelines. Experts scoring of pelvic compartment delineation and reporting template were collected; responses were analyzed and classified as “RECOMMENDED” versus “NOT RECOMMENDED” (when ≥ 80% consensus among experts) or uncertain (when < 80% consensus among experts).
Consensus regarding pelvic compartment delineation and DIE reporting was attained using the RAND-UCLA Appropriateness Method. The pelvis was divided in nine compartments and extrapelvic lesions were assigned to an additional (tenth) compartment. A consensus was also reached for each structure attributed to a compartment and each reporting template item among the experts. No consensus was reached for a normal aspect of uterosacral ligament, but a consensus was reached for an unequivocal involvement leading to a positive diagnosis and an equivocal involvement leading to uncertain diagnosis. Tailored MRI lexicon and standardized region-based report were proposed.
These consensus recommendations should be used as a guide for DIE reporting and staging with MRI. Standardized MRI compartment-based structured reporting is recommended to enable consistent accuracy and help select the best therapeutic approach.
Structured report for dynamic ultrasonography in patients with suspected or known endometriosis: Recommendations of the International Society for Gynecologic Endoscopy (ISGE)
2021, European Journal of Obstetrics and Gynecology and Reproductive Biology
Citation Excerpt :
The lesion side and size in three orthogonal planes should be presented in the US report. It is important to describe whether the lesion is isolated or if it is a part of a larger nodule extending into the vagina and/or other surrounding structures since partial vaginectomy is necessary for complete resection of the lesions invading up to the vaginal mucosa while it is usually possible to shave off the retrocervical lesion adherent or partially invading the muscular layer of the posterior vaginal fornix [9]. Rectum.
The International Society for Gynecologic Endoscopy (ISGE) developed this project to establish the recommendations for structured reporting of dynamic ultrasound findings, promoting on this manner the practice of standardized, comprehensive and systematic evaluation and reporting of endometriosis in pelvic structures, in correlation with the #Enzian classification.
A non-systematic review was done through a search on the following databases: MEDLINE, EMBASE, Global Health, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register), Health Technology Assessment Database and Web of Science, using the medical subject heading (MeSH) term “endometriosis” (MeSH Unique ID: D004715) in combination with “diagnostic imaging” (MeSH Unique ID Q000000981) and “consensus” (MeSH Unique ID D032921). The information extracted from the articles of interest, written in English and published from inception of the above-mentioned databases until May 2021, was graded by the level of evidence using the American College of Chest Physicians (ACCP) classification system. The recommendations for a structured reporting of ultrasound findings were developed through multiple cycles of literature analysis and expert discussion following the Delphi method.
The ISGE recommends the adoption of the terms, definitions and methods proposed by the International Deep Endometriosis Analysis (IDEA) Group for ultrasound assessment of patients with suspected or known endometriosis (grade 1C), since this is the most comprehensive and systematic concept currently available. This paper provides the ISGE structured reporting template for presenting quantitative and qualitative information upon the IDEA consensus-based sonographic assessment of the uterus, adnexa, anterior and posterior compartment. The #Enzian classification is recommended to summarize the findings in a standard fashion (grade 1B).
Mapping of pelvic endometriosis by ultrasound is accurate when trained sonographers perform the technique. Structured reporting of the lesions may improve patient counseling and treatment planning, including the organization of multidisciplinary teams and the selection of the most appropriate medical or surgical therapeutic strategy.
Impact of Surgery for Deep Infiltrative Endometriosis before In Vitro Fertilization: A Systematic Review and Meta-analysis
2021, Journal of Minimally Invasive Gynecology
The aims of this systematic review and meta-analysis were to compare reproductive outcomes in patients who underwent surgery for deep infiltrative endometriosis (DIE) before in vitro fertilization (IVF) with those in patients who underwent IVF without a previous surgery for DIE, to analyze data according to different types of surgery (complete or incomplete) or subgroups of patients (DIE with or without bowel involvement), and to assess surgical and IVF complications and data regarding safety concerns.
A systematic literature search from January 1980 to November 2019 with no language restriction was performed in PubMed, MEDLINE, Embase, and Web of Science. The search strategy used the following Medical Subject Headings terms: “in vitro,” “fertilization,” “IVF,” “assisted reproduction,” “colorectal,” “endometriosis,” “deep,” “infiltrating,” “deep infiltrative endometriosis,” “intestinal,” “bowel,” “rectovaginal,” “uterosacral,” “vaginal,” and “bladder.”
We included studies that compared reproductive outcomes in women with infertility with DIE who received IVF with or without a previous surgery for DIE lesions. Meta-analysis was performed using Review Manager (RevMan v.5.3; Cochrane Training, London, United Kingdom). The risk of bias of the included studies was assessed using the method recommended by Cochrane Collaboration.
The systematic search retrieved 150 articles; 98 studies were potentially eligible, and their full texts were reviewed. Of these, 12 studies met our inclusion criteria, and 5 presented data suitable for inclusion in a meta-analysis; however, 2 of the studies provided overlapping data, and only the larger study was finally included. No randomized controlled trials (RCTs) were found. The pregnancy rate per patient was 1.84 (95% confidence interval [CI], 1.28–2.64), the pregnancy rate per cycle was 1.84 (95% CI, 1.26–2.70), and the live birth rate per patient was 2.22 (95% CI, 1.42–3.46) times more likely for operated patients than for nonoperated ones. The addition of data from the incomplete surgery groups also showed a higher pregnancy rate per patient for surgery before IVF (odds ratio [OR] 1.63; 95% CI, 1.16–2.28). The results favor previous surgery in DIE with digestive involvement (OR 2.43; 95% CI, 1.13–5.22) and also in DIE without digestive involvement (OR 1.55; 95% CI, 0.61–3.95). A qualitative analysis of the complications of surgery and IVF showed a partial or complete lack of information on these issues as well as high heterogeneity in the reported data. None of these studies is an RCT; therefore, all have a high risk of selection and allocation bias, except for 1 study that statistically controlled the latter risk by using propensity scores. Funnel plots showed no asymmetry.
The results were very consistent for all the studied outcomes, showing a statistically significant benefit for surgery before IVF, although they should be confirmed with RCTs. In addition to the reproductive outcomes, safety data should also be reported to obtain a complete assessment of the risks and benefits.
Laparoscopic Treatment of Ureteral Endometriosis: A Systematic Review
2021, Journal of Minimally Invasive Gynecology
To review the literature for the preoperative clinical characteristics, surgical findings, and outcomes of patients who underwent laparoscopic surgical treatment of ureteral endometriosis (UE).
A systematic search was performed in the PubMed and Scopus databases.
Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, studies in English language that assessed UE treated surgically by laparoscopy published between 2008 and 2020 were selected.
In an initial search, 1313 articles were identified, 193 in PubMed and 1120 in Scopus databases. A total of 1291 articles that did not meet eligibility criteria were excluded. The remaining 22 studies were included in the final qualitative analysis, with a total of 1337 patients. Data on preoperative patient's characteristics, preoperative imaging examinations, intraoperative findings, and postoperative complications were abstracted by 1 author. The descriptive nature of included studies prevented the performance of meta-analysis. Preoperative symptoms included dysmenorrhea (76.3%), pelvic pain (59.6%), dyspareunia (46.2%), lower urinary tract symptoms (21.3%), and ureteral obstructive symptoms (9.9%). Intraoperative findings showed that UE lesions were left-sided in 55% of the cases, right-sided in 28.9% of the cases, and bilateral in 8.7% of the cases. Ureterolysis alone or before another technique was performed in 69.1% of the cases, ureteral resection followed by ureteroureteral anastomosis in 6%, ureteroneocystostomy after ureteral resection in 21%, and nephrectomy in 0.45% of the patients. Double-J ureteral stent placement was reported in 33.3% of the cases. Concomitant resection of the bladder owing to endometriosis involvement was performed in 15.5% of the cases. The prevalence of ureteral injury was 3.1%. Postoperative complications included ureteral fistula (2.8%), ureteral stenosis (24.2%), persistence/recurrence of UE (3.8%), and reoperation for fistula and/or stricture treatment (3.9%).
UE is associated with common endometriosis pain symptoms and a low rate of lower urinary tract symptoms. The standard surgical technique for UE treatment is not yet a consensus; however, the laparoscopic approach with previous ureterolysis, leaving ureteral resection only for refractory cases, seems to be a safe and effective treatment, with improvement of symptoms and few intraoperative and postoperative complications.
Comparison between conventional and structured magnetic resonance imaging reports in perianal fistula
2020, Journal of Coloproctology
Citation Excerpt :
Gassenmaier et al.7 demonstrated the advantage of structured reporting on shoulder MRI. The Korean Society of Radiology has published a consensus of MRI structured reporting on rectal cancer,8 while other authors have shown the benefits of structured MRI reporting on multiple sclerosis,9 endometrial cancer,10 and endometriosis.11 In the study of anal fistula, there are already other publications regarding the structured MRI report, which allows us to make comparisons with the results obtained here, although they are different reports and the method of analysis is not exactly the same as the one used here.
Very often magnetic resonance imaging is used in the study of complex anal fistulae, but conventional reports may contribute little to what really matters to the coloproctologist.
To compare the clarity and usefulness of the conventional report compared to structured magnetic resonance imaging in cases of anal fistula.
30 magnetic resonance exams already performed with an evaluation of anal fistula were again evaluated without the radiologist having access to the old report and a new structured report was prepared. Five proctologists evaluated the 30 conventional and 30 structured reports and answered questionnaires with eight questions comparing their practical aspects. The results were tabulated and submitted to statistical treatment considering a significant p < 0.05.
There was a statistically significant difference in favor of the structured report in the questions “clearly defines whether it is an active fistula or fibrosis”, “clearly states whether the tract is single or multiple”, “whether the patient has anal fistula or not”. The other questions did not present differences between the groups.
The structured magnetic resonance report presented clearer information and was better evaluated in relation to the conventional one in the analysis of proctologists in the study of anal fistulae.
Com muita frequência utiliza-se ressonância magnética no estudo de fístulas anais complexas, porém, laudos convencionais podem contribuir pouco para o que realmente importa ao coloproctologista.
Comparar a clareza e utilidade do laudo convencional com uma proposta de laudo estruturado de ressonância magnética em casos de fístula anal.
30 exames de ressonância magnética já com laudo realizados para avaliação de fístula anal foram novamente avaliados sem que o radiologista tivesse acesso ao laudo antigo e foi confeccionado novo laudo estruturado. Cinco médicos proctologistas avaliaram os 30 laudos convencionais e os 30 estruturados e responderam a questionários com oito questões comparando aspectos práticos dos mesmos. Os resultados foram tabulados e submetidos a tratamento estatístico considerando-se significante p < 0,05.
Houve diferença estatisticamente significante em favor do laudo estruturado nos quesitos “define claramente se é fistula ativa ou fibrose”, “declara claramente se o trajeto é único ou múltiplo”, “fica clara a informação se o paciente tem ou não fistula anal”. Os demais quesitos não apresentram diferença entre os grupos.
O laudo estruturado de ressonância magnética apresentou informações mais claras e foi melhor avaliado em relação ao convencional na análise dos proctologistas no estudo de fístulas anais.
MRI of endometriosis in correlation with the #Enzian classification: applicability and structured report
2023, Insights into Imaging

View all citing articles on Scopus

: Drs. Kho, Young, and Abrao are consultants for Abbvie.

View full text

PerspectivesStructured Ultrasound and Magnetic Resonance Imaging Reports for Patients with Suspected Endometriosis: Guide for Imagers and Clinicians

Abstract

Section snippets

Methods

Conclusion

Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis, including terms, definitions and measurements: a consensus opinion from the International Deep Endometriosis Analysis (IDEA) group

Ultrasound Obstet Gynecol

Ultrasound mapping system for the surgical management of deep infiltrating endometriosis

Fertil Steril

Diagnostic laparoscopy in pre-surgical planning for higher stage endometriosis: is it still relevant?

Aust N Z J Obstet Gynaecol

ESHRE guideline: management of women with endometriosis

Hum Reprod

Comparison between clinical examination, transvaginal sonography and magnetic resonance imaging for the diagnosis of deep endometriosis

Hum Reprod

Imaging modalities for the non-invasive diagnosis of endometriosis

Cochrane Database Syst Rev

Can we improve the prediction of pouch of Douglas obliteration in women with suspected endometriosis using ultrasound-based models? A multicenter prospective observational study

Acta Obstet Gynaecol Scand

Initial accuracy of and learning curve for transvaginal ultrasound with bowel preparation for deep endometriosis in a US tertiary care center

J Minim Invasive Gynecol

Evaluation of the sacral nerve plexus in pelvic endometriosis by three-dimensional MR neurography

J Magn Reson Imaging

European Society of Urogenital Radiology (ESUR) guidelines: MR imaging of pelvic endometriosis

Eur Radiol

Structured versus narrative reporting of pelvic MRI in perianal fistulizing disease: impact on clarity, completeness, and surgical planning

Abdom Radiol (NY)

Deep endometriosis infiltrating the recto-sigmoid: critical factors to consider before management

Hum Reprod Update

Surgery for bladder endometriosis: long-term results and concomitant management of associated posterior deep lesions

Hum Reprod

Perspectives
Structured Ultrasound and Magnetic Resonance Imaging Reports for Patients with Suspected Endometriosis: Guide for Imagers and Clinicians