MRI Staging Of Pelvic Endometriosis

PurposeThis study set the scores and staging criteria for MRI signs of pelvic endometriosis,and explored the consistency of this staging with rASRM laparoscopic staging,providing surgeons with more convenient preoperative reference information.Materials and Methods1.From March 2013 to March 2018,75 patients who underwent pelvic MRI examination before laparoscopic surgery and were diagnosed pelvic endometriosis by histopathological examination were involved in this study in General Hospital of Tianjin Medical University.2.The MRI staging criteria for pelvic endometriosis involving 4 stages is as follows.Stage I(slight)is from1 to 5,and stage II(mild)is from 6 to 15,stage III(moderate)is from 16 to 40,stage IV(severe)is more than 40;the main signs to assess involved the size of endometriotic cyst,wall thickness,separation,“satellite cysts” or “the sign of the capsule wall gap”,the mixed-signal intensity on T2 WI,and the evaluation of the signs of posterior cul-de-sac obliteration,including retroflexed uterus,elevation of the fornix,retrouterine implantation lesion,displacement of intraperitoneal fluid,and adherence of bowel loops.3.MRI staging was performed by two radiologists with 3 years of experience in abdominal MRI diagnosis,and Kappa test was used for consistency analysis with rASRM laparoscopic staging results.Results1.Of the 75 patients,105 ovarian endometriotic cysts and 7 deep invasive endometriosis were detected by laparoscopic surgery,2 of which were located in the rectum,2 in the ureter,and 2 in the uterine ligament,1 case is located in the broad ligament of the uterus.A total of 103 ovarian endometriotic cysts were detected by MRI,including 28 cases of bilateral(37.3%),47 cases of unilateral(62.7%),2 cases of rectal endometriosis and 1 case of ureteral uterus.There was no one diagnoed stage I whatever in the rASRM laparoscopic staging or MRI staging,After comparing the MRI staging with the rASRM laparoscopic staging,the radiologist 1 found that 71 of the 75 patients had consistent staging and 4 patients were not;the radiologist 2 found that 67 of the 75 patients had the same staging and 8patients were not.Kappa statistical analysis was performed on the MRI staging results and the rASRM staging results,respectively,and the Kappa values were all >0.75,p<0.001,which proved that there was better agreement between the two staging systems.ConclusionThe study of 75 cases of endometriosis proved that the MRI staging of this study and the rASRM laparoscopic staging have a good agreement,which effectively proves the advantage of the preoperative staging of MRI in endometriosis.Preoperative MRI examination,which was non-invasive and effective,is of great significance for patients with endometriosis to chose the most suitable clinical treatment.