1,721,036 research outputs found
Effectiveness of magnetic resonance imaging and MDCT- enteroclysis in the diagnosis of bowel endometriosis
No full textIntroduction: Although various techniques have been proposed for the diagnosis of bowel endometriosis, no gold standard is currently available. The objective of this study is to compare the effectiveness of magnetic resonance imaging (MRI) and multidetector computerized tomography enteroclysis (MDCTe) in determining the presence of bowel endometriotic nodules and the depth of infiltration of the nodules in the bowel wall.
Materials and methods: This prospective study included 26 women (median age, 32 years; range, 19 – 38) with pain and gastrointestinal symptoms suggestive of colorectal endometriosis (diarrhea, constipation, painful bowel move- ments, dyschezia, rectorrhagia). Patients underwent MRI (1T magnet, phased array coil, multiplanar FSET1, T1 fat sat, T2, T1 post-Gado sequences) and MDCTe (16-row MDCT scanner). MDCTe was performed after intestinal preparation, hypotonisation, and retrograde colon distension (obtained introducing 2000 ml of water). After the injection of iodinated contrast medium, the patient was scanned from the dome of the diaphragm to the pubic symphysis. The exams were reviewed independently and blindly by two radiologists. All women underwent laparoscopy within 2 weeks from imaging. After ade- quate adhesiolysis, last part of the ileum, caecum, colon, and rectum were systematically examined; all endometriotic nodules were excised by either nodulectomy (partial or full thickness) or bowel resection. Radiological findings were compared with surgical and histological data. Statistical analysis was performed by using SPSS 13.0; sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated by using the CATmaker software.
Results: Bowel endometriosis was detected by MRI in 11 (42.3%) women and by MDCTe in 12 (46.2%) women. Surgery confirmed the presence of bowel endometriosis in the 12 patients identified by MDCTe. In the diagnosis of patients with bowel endometriosis, sensibility, specificity, PPV, and NPV were 91.7%, 100%, 100%, 93.3% for MRI and 100%, 100%, 100%, 100% for MDCTe. 21 nodules were identified by MRI and 22 by MDCTe; surgery identified a total of 25 nodules, they were located on the rectum (n 1⁄4 13), the sigmoid colon (n 1⁄4 11), caecum (n 1⁄4 1). All nodules missed by MRI andMDCTe were located on the rectum. One false positive nodule was observed at MDCTe and it was judged to reach the serosa. Among the nodules correctly identified at MRI, the depth of infiltration in the bowel wall was estimated to reach the serosa in 8 cases and the muscularis in 13 cases. At MDCTe, 4 nodules were judged to infiltrate the serosa, 16 nodules to reach the muscularis propria, and 1 reached to reach the mucosa. MDCTe correctly estimated the depth of infiltration of the nodules significantly more frequently than MRI (P 1⁄4 0.048).
Conclusions: Both MRI and MDCTe can reliably detect the presence of bowel endometriotic nodules; however, MDCTe is more accurate in estimating the depth of infiltration of the nodules in the bowel wall
The comparison between MRI and MSCT-enteroclysis in the diagnosis of bowel endometriosis
No full textPurpose: To compare the effectiveness of MRI and MSCT-enteroclysis (MSCTe) in determining the presence of bowel endometriosis (BEM) and the depth of bowel wall infiltration of the nodules. Material and methods: We evaluated 26 women (aged 19–38) with signs and symptoms suggestive of colorectal endometriosis. Patients underwent MRI (1T magnet, phased array coil, multiplanar FSET1, T1 fat sat, T2, T1 post-Gado sequences) and MSCTe (16 rows). The exams were reviewed independently by two radiologists. All women underwent laparoscopy within 2 weeks; radiological findings were compared with surgical and histological data. Statistical analysis was performed with SPSS 13.0. Results: The presence of BEM was detected by MRI in 11 (42.3%) women and by MSCTe in 12 (46.2%). Surgery confirmed BEM in 12 patients identified by MSCTe. In the diagnosis, sensibility, specificity, PPV, NPV were 91.7, 100, 100, 93.3% for MRI and 100, 100, 97, 100% for MSCTe. 21 nodules were identified by MRI and 22 by MSCTe; surgery identified 25 nodules: 13 located on the rectum, 11 at sigmoid colon, and 1 at caecum. One false positive nodule was observed at MSCTe. Among correctly identified nodules, MRI estimated the depth of infiltration to the serosa in 8 cases and to the muscularis in 13. At MSCTe, 4 nodules were judged to infiltrate the serosa, 16 to reach the muscularis propria, and 1 the mucosa. MSCTe correctly estimated the depth of nodules infiltration, significantly more frequently than MRI (p=0.048; Fisher‘s exact test). Conclusion: Both MRI and MSCTe reliably detect the BEM nodules; however, MSCTe is more accurate in estimating the depth of infiltration in the bowel wall
Aromatase inhibitors in the treatment of bladder endometriosis
No full textBackground. Aromatase inhibitors have recently been proposed for the treatment of endometriosis; however, no previous study examined the effects of these agents on pain and urinary symptoms of premenopausal women with bladder endometriosis. Case. Two premenopausal patients with bladder endometriosis were treated with letrozole (2.5 mg/day), norethisterone acetate (2.5 mg/day), elemental calcium and vitamin D3 for 6 months. The double-drug regimen quickly improved pain and urinary symptoms in both patients. One patient had no significant adverse effect and continued the therapy for 14 months. The other patient developed myalgia and severe arthralgia; pain and urinary symptoms recurred few months after the interruption of the 6-month treatment and the patient underwent laparoscopic partial cystectomy. Conclusion. Aromatase inhibitors improve pain and urinary symptoms in patients with bladder endometriosis; however, severe side effects of treatment may occur. These agents should be administered only to patients who refuse surgery and fail to respond to other therapies. © 2011 Informa UK, Ltd
MDCT enteroclysis with split bolus technique provides additional information on the urinary tract in patients with suspected bowel endometriosis
No full textIntroduction: Multidetector computerized tomography enteroclysis (MDCTe) has been demonstrated to be accurate in the diagnosis of bowel endometriosis. In this study we present a modified protocol of MDCTe which allows to study the urinary tract without increasing the radiation dose imparted to the patients. Materials and methods: This prospective study included 103 women who underwent laparoscopy because of pain and gastrointestinal symptomssuggestive of pelvic and colorectal endometriosis. Women with a previous diagnosis of urolithiasis were excluded from the study. Colonic distension was achieved by introducing 2000–2300ml of water (378C). The same iodine load per patient body weight (7.4 mg/kg) was administered. The intra- venous contrast material (c.m.) was administered by using a split bolus technique. 20% of the c.m. was administered at a rate of 1 ml/s during colon distension (8 minutes before starting the volumetric acquisition). After injec- tion of the remaining quantity of the c.m, the volumetric acquisition was per- formed during the portal phase of the c.m. (40 s after the arterial peak). One volumetric acquisition was performed from the dome of the diaphragm to the pubic symphysis. Examinations were performed on a 16-row MDCT scanner (LightSpeed, GE Medical Systems, Waukesha, Wisconsin, USA). In addition to axial images, coronally and sagittally reformatted multiplanar reconstructions, maximum-intensity- projections, average-intensity-projections images were generated on an Advantage workstation (AW 4.2, GE Healthcare). Images were evaluated on a PACS workstation (Centricity, GE Healthcare) by two radiologists. The presence of bowel endometriotic nodules and the depth of infiltration of the nodules in the bowel wall were determined. The radiologists classified ureteral opacification as poor, sufficient, and good. When the ureter was opa- cified between the crossing of the iliac vessels and the bladder, the radiol- ogists determined whether ureteral compression was present. Radiological findings were compared with surgical and histological results. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, positive likelihood ratio (LRþ), and negative likelihood ratio (LR2) were calculated by using the CATmaker software (CEBM, Oxford, UK).
Results: Surgery revealed that 67 women (65.0%) had bowel endometriotic nodules. The sensitivity of MDCTe in identifying bowel nodules was 95.5%, the specificity 97.2%, the PPV 98.5%, the NPV 92.1%, the accuracy 96.1%, the LRþ 34.39, and the LR- 0.05. Three bowel nodules were not detected by MDCTe; they were all located on the rectum. The effectiveness of MDCTe was also determined for the diagnosis of bowel nodules infiltrating at least the muscular layer. In this analysis the sensibility of MDCTe was 93.3%, the specificity 96.6%, the PPV 95.5%, the NPV 94.9%, the accuracy 95.1%, the LRþ 27.07, and the LR- 0.07. One patient had a double ureter. Ureteral opacification was judged to be poor in 17 cases (8.2%), suf- ficient in 36 cases (17.4%), and good in 154 cases (74.4%). The renal cav- ities were well detected in all cases; no hydronephrosis was observed. Compression of the distal ureter was observed at MDCTe in 36 cases (17.4%); surgery confirmed the presence of ureteral compression in 34 cases (16.4%); therefore, there were two false positive at MDCTe. In 137 cases laparoscopic examination of the ureters revealed the presence of super- ficial endometriotic lesions involving the peritoneum overlying the ureters; however, no ureteral compression was observed. The sensitivity of MDCTe in identifying ureteral compression was 97.1%, the specificity 98.8%, the PPV 94.4%, the NPV 99.4%, the accuracy 99.0%, the LRþ 83.54, and the LR20.03.
Conclusions: Applying the split bolus technique to MDCTe allows diagnosing ureteral endometriosis and does not compromise the accuracy in the detection of bowel endometriosis
Retroperitoneal fibrosis caused by barium: complication of rectal perforation during double contrast enema of the colon. Report of a case
No full text
Other imaging techniques: Double-contrast barium enema, endoscopic ultrasonography, multidetector CT enema, and computed tomography colonoscopy
No full textDouble-contrast barium enema (DCBE), transrectal endoscopic ultrasonography (REU), multidetector computerized tomography enema (MDCT-e), and computed tomography colonoscopy (CTC) have been successfully used for the diagnosis of bowel endometriosis. DCBE provides a complete overview of the entire colon and allows detecting cecal nodules. The accuracy of DCBE is operator dependent and, thus, it may have low specificity. It does not allow identifying the cause of the mass effect. DCBE requires the administration of barium and exposure to radiation. REU precisely estimates the distance between the rectosigmoid nodule and the anal verge. However, it allows investigating only the distal part of rectosigmoid, it misses anterior pelvic lesions, and it has poor sensitivity for the diagnosis of endometriomas. MDCT-e is accurate and reproducible in diagnosing intestinal endometriosis and in assessing its characteristics: the largest diameter of the nodule, the distance between the distal part of the nodule and the anal verge, and depth of infiltration of endometriosis in the intestinal wall. MDCT-e requires the administration of iodinated contrast medium (CM) and the exposure to radiations. CTC has good performance in the diagnosis of rectosigmoid endometriosis. It allows estimating the degree of intestinal stenosis CTC, and the distance between the intestinal endometriotic nodule and the anal verge. It requires exposure to radiations, and it may require the administration of an iodinated CM
Preoperative evaluation of an appendiceal mucocele in a woman with endometriosis
No full textAppendiceal mucocele is a rare cause of pain in the right lower abdominal quadrant. This case report describes a case of coexistence of endometriosis and appendiceal mucocele, which were diagnosed preoperatively by computed tomography, magnetic resonance imaging and ultrasonography. Laparoscopic excision of the appendiceal mucocele and endometriosis resulted in the disappearance of the symptoms. © 2013 Wichtig Editore
Magnetic resonance with gel enema (MR-e) versus computed tomographic colonography (CTC) for diagnosing rectosigmoid endometriosis
No full textEffectiveness of magnetic resonance imaging and MDCT- enteroclysis in the diagnosis of bowel endometriosis
No full textIntroduction: Although various techniques have been proposed for the diagnosis of bowel endometriosis, no gold standard is currently available. The objective of this study is to compare the effectiveness of magnetic resonance imaging (MRI) and multidetector computerized tomography enteroclysis (MDCTe) in determining the presence of bowel endometriotic nodules and the depth of infiltration of the nodules in the bowel wall.
Materials and methods: This prospective study included 26 women (median age, 32 years; range, 19 – 38) with pain and gastrointestinal symptoms suggestive of colorectal endometriosis (diarrhea, constipation, painful bowel move- ments, dyschezia, rectorrhagia). Patients underwent MRI (1T magnet, phased array coil, multiplanar FSET1, T1 fat sat, T2, T1 post-Gado sequences) and MDCTe (16-row MDCT scanner). MDCTe was performed after intestinal preparation, hypotonisation, and retrograde colon distension (obtained introducing 2000 ml of water). After the injection of iodinated contrast medium, the patient was scanned from the dome of the diaphragm to the pubic symphysis. The exams were reviewed independently and blindly by two radiologists. All women underwent laparoscopy within 2 weeks from imaging. After ade- quate adhesiolysis, last part of the ileum, caecum, colon, and rectum were systematically examined; all endometriotic nodules were excised by either nodulectomy (partial or full thickness) or bowel resection. Radiological findings were compared with surgical and histological data. Statistical analysis was performed by using SPSS 13.0; sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated by using the CATmaker software.
Results: Bowel endometriosis was detected by MRI in 11 (42.3%) women and by MDCTe in 12 (46.2%) women. Surgery confirmed the presence of bowel endometriosis in the 12 patients identified by MDCTe. In the diagnosis of patients with bowel endometriosis, sensibility, specificity, PPV, and NPV were 91.7%, 100%, 100%, 93.3% for MRI and 100%, 100%, 100%, 100% for MDCTe. 21 nodules were identified by MRI and 22 by MDCTe; surgery identified a total of 25 nodules, they were located on the rectum (n 1⁄4 13), the sigmoid colon (n 1⁄4 11), caecum (n 1⁄4 1). All nodules missed by MRI andMDCTe were located on the rectum. One false positive nodule was observed at MDCTe and it was judged to reach the serosa. Among the nodules correctly identified at MRI, the depth of infiltration in the bowel wall was estimated to reach the serosa in 8 cases and the muscularis in 13 cases. At MDCTe, 4 nodules were judged to infiltrate the serosa, 16 nodules to reach the muscularis propria, and 1 reached to reach the mucosa. MDCTe correctly estimated the depth of infiltration of the nodules significantly more frequently than MRI (P 1⁄4 0.048).
Conclusions: Both MRI and MDCTe can reliably detect the presence of bowel endometriotic nodules; however, MDCTe is more accurate in estimating the depth of infiltration of the nodules in the bowel wall
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