Interdisciplinary Department of Medicine, Section of Radiology, University of Bari Medical School, Italy.
Clin Radiol. 2013 Sep;68(9):895-901. doi: 10.1016/j.crad.2013.02.013. Epub 2013 Jul 1.
To evaluate the accuracy of water enema computed tomography (CT) for predicting the location of endometriosis in patients with contraindications to magnetic resonance imaging (MRI), focusing on rectosigmoid lesions and having laparoscopic and histological data as the reference standard.
Thirty-three women (mean age 33.4 ± 3.1 years) suspected of having deep pelvic endometriosis underwent 64-row CT and video laparoscopy within 4 weeks. Two radiologists blinded to the clinical data evaluated the CT images obtained after colonic retrograde distension using water as the contrast medium, and a comparison with laparoscopic and histological findings was performed. CT sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated. The radiation dose to patients was estimated. Cohen's weighted kappa (κ) test was used to evaluate the interobserver agreement.
In 23 out of 33 patients (69%) intestinal implants were found at surgery and pathological examinations. CT confirmed the diagnosis of rectosigmoid endometriosis in 20 out of 23 implants. Three nodules located on the proximal sigmoid colon (two serosal lesions and one infiltrating the muscularis layer) with a diameter of less than 1 cm were not diagnosed. CT sensitivity, specificity, PPV, NPV, and accuracy values were 87, 100, 100, 77, and 91%, respectively. The mean effective dose estimate was 6.30 ± 1.7 mSv. Almost perfect agreement between the two readers was found (k = 0.84).
Water enema CT can play a role in the diagnosis of bowel endometriosis and represents another accurate potential tool for video laparoscopic approaches, especially in patients for whom MRI is contraindicated.
评估水灌肠计算机断层扫描（CT）在预测有磁共振成像（MRI）禁忌证的患者中子宫内膜异位症位置的准确性，重点关注直肠乙状结肠病变，并以腹腔镜和组织学数据为参考标准。
33 名（平均年龄 33.4 ± 3.1 岁）疑似患有深部盆腔子宫内膜异位症的女性在 4 周内接受了 64 排 CT 和视频腹腔镜检查。两位对临床数据不知情的放射科医生在结肠逆行扩张后使用水作为对比剂评估 CT 图像，并与腹腔镜和组织学结果进行比较。计算 CT 敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和诊断准确性。估计患者的辐射剂量。采用 Cohen 加权κ（κ）检验评估观察者间的一致性。
在 33 名患者中有 23 名（69%）在手术和病理检查中发现肠内植入物。CT 在 23 个植入物中的 20 个中证实了直肠乙状结肠子宫内膜异位症的诊断。三个位于近端乙状结肠的结节（两个浆膜病变和一个浸润肌层）直径小于 1cm，未被诊断出来。CT 的敏感性、特异性、PPV、NPV 和准确性分别为 87%、100%、100%、77%和 91%。平均有效剂量估计值为 6.30 ± 1.7mSv。两位读者之间发现了几乎完美的一致性（k=0.84）。
水灌肠 CT 可在肠子宫内膜异位症的诊断中发挥作用，并且是视频腹腔镜方法的另一种准确的潜在工具，尤其是在 MRI 禁忌证的患者中。
