与子宫内膜异位症相关的直肠子宫陷凹闭塞：磁共振成像评估

Posterior cul-de-sac obliteration associated with endometriosis: MR imaging evaluation.

作者信息

Kataoka Milliam L, Togashi Kaori, Yamaoka Toshihide, Koyama Takashi, Ueda Hiroyuki, Kobayashi Hisataka, Rahman Mahbubur, Higuchi Toshihiro, Fujii Shingo

机构信息

Department of Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.

出版信息

Radiology. 2005 Mar;234(3):815-23. doi: 10.1148/radiol.2343031366. Epub 2005 Jan 21.

DOI:10.1148/radiol.2343031366

PMID:15665220

Abstract

PURPOSE

To retrospectively evaluate the accuracy of magnetic resonance (MR) imaging in depicting posterior cul-de-sac obliteration in patients with endometriosis.

MATERIALS AND METHODS

Institutional review board approval was not required for this retrospective study, but informed consent was obtained from all patients. MR images obtained between January 1989 and December 2000 in 57 women (mean age, 39 years; age range, 26-52 years) with histologically confirmed endometriosis were retrospectively evaluated by four radiologists independently. All patients underwent laparotomy or laparoscopy less than 1 month after MR imaging. MR images were evaluated for the presence and location of endometrial implants and adhesions. MR images were also scored for the presence of five findings: retroflexed uterus, elevated posterior vaginal fornix, intestinal tethering or tethered appearance of rectum in direction of uterus, faint strands between uterus and intestine, and fibrotic plaque or nodule covering serosal surface of the uterus. Interobserver agreement for each of the five findings and for the overall diagnosis of cul-de-sac obliteration was calculated. Sensitivity, specificity, accuracy, positive and negative predictive values, and kappa statistics were determined.

RESULTS

Laparotomy or laparoscopy revealed posterior cul-de-sac obliteration in 30 patients. Overall, the four radiologists had mean accuracies of 89.0% and 76.3% for diagnosing endometrial implants and adhesions, respectively, at MR imaging. Overall, the radiologists achieved mean sensitivity, specificity, accuracy, and positive and negative predictive values of 68.4%, 76.0%, 71.9%, 76.6%, and 68.5%, respectively, in diagnosing posterior cul-de-sac obliteration. The best accuracy (mean value, 64.5%) was obtained with the finding of fibrotic plaque in the uterine serosal surface. Readers agreed on the observations 63.2%-91.2% of the time. For the impression of the presence or absence of posterior cul-de-sac obliteration, interobserver agreement varied between substantial and moderate: Mean interobserver agreement was 78.4% (range, 70.2%-84.2%), and mean kappa was 0.57 (range, 0.40-0.67). Mean accuracy of MR imaging for diagnosing posterior cul-de-sac obliteration was 71.9%.

CONCLUSION

These results suggest that use of the described MR imaging findings may enable diagnosis of posterior cul-de-sac obliteration.

摘要

目的

回顾性评估磁共振成像（MR）描绘子宫内膜异位症患者直肠子宫陷凹闭塞的准确性。

材料与方法

本回顾性研究无需机构审查委员会批准，但已获得所有患者的知情同意。对1989年1月至2000年12月期间57例经组织学证实为子宫内膜异位症的女性（平均年龄39岁；年龄范围26 - 52岁）的MR图像进行回顾性评估，由四位放射科医生独立进行。所有患者在MR成像后不到1个月接受了剖腹手术或腹腔镜检查。对MR图像评估子宫内膜植入物和粘连的存在及位置。还对MR图像进行五项表现评分：子宫后屈、阴道后穹窿抬高、肠管牵拉或直肠向子宫方向的牵拉外观、子宫与肠管之间的模糊条索以及覆盖子宫浆膜表面的纤维化斑块或结节。计算五位观察者对五项表现中每一项以及直肠子宫陷凹闭塞总体诊断的一致性。确定敏感性、特异性、准确性、阳性和阴性预测值以及kappa统计量。

结果

剖腹手术或腹腔镜检查发现30例患者存在直肠子宫陷凹闭塞。总体而言，四位放射科医生在MR成像中诊断子宫内膜植入物和粘连的平均准确率分别为89.0%和76.3%。总体而言，放射科医生在诊断直肠子宫陷凹闭塞时的平均敏感性、特异性、准确性、阳性和阴性预测值分别为68.4%、76.0%、71.9%、76.6%和68.5%。子宫浆膜表面纤维化斑块这一表现的诊断准确性最高（平均值为64.5%）。观察者之间在63.2% - 91.2%的时间内意见一致。对于直肠子宫陷凹闭塞是否存在的判断，观察者间一致性在实质性和中等程度之间变化：观察者间平均一致性为78.4%（范围70.2% - 84.2%），平均kappa值为0.57（范围0.40 - 0.67）。MR成像诊断直肠子宫陷凹闭塞的平均准确率为71.9%。