Jeong Soh-Yong, Chung Dong-Jin, Myung Yeo Dong, Lim Yong-Tec, Hahn Sung-Tae, Lee Jae-Mun
From the Department of *Radiology and †Gynecology, Yeouido St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
J Comput Assist Tomogr. 2013 Sep-Oct;37(5):809-14. doi: 10.1097/RCT.0b013e318299ddc5.
We wanted to assess the diagnostic value and morphologic feature of deep infiltrating endometriosis (DIE), involving rectosigmoid colon, with computed tomography (CT) colonography in comparison with magnetic resonance (MR).
Fifty patients with DIE, who had undergone CT colonography and MR imaging (MRI) before surgery, were enrolled. Among these 50 patients who underwent laparoscopic surgery with DIE, 37 patients were diagnosed as rectosigmoid involvement of endometriosis (presence of rectal outer wall involvement, endometrial implantation in the rectouterine space, and complete obliteration of cul-de-sac with histologic confirmation). Image findings at CT colonography and MRI were reviewed by 2 radiologists to determine whether there are radiologic features that can help predict rectosigmoid endometriosis. Computed tomography images were analyzed for the luminal alteration of rectosigmoid colon, mural thickening, and mass formation in the rectosigmoid colon, whereas MR images were analyzed for the mass formation in the rectosigmoid colon, fat plane obliteration, between rectum and uterus or vagina, retroversion of uterus, retraction of uterus toward the colon, and detection of endometrial spot in rectovaginal or rectouterine space. Statistical analysis was performed with Pearson χ and receiver operating characteristic curve.
With CT colonography, the luminal alteration of rectosigmoid colon was detected with sensitivity of 96.0% and specificity of 48.0% (P < 0.001) in the overall rectosigmoid endometriosis and with sensitivity of 84.0% and specificity of 80.0% (P = 0.005) in the case of DIE with cul-de-sac obliteration. With MR, the sensitivity and specificity for detection of endometriosis of rectosigmoid or rectouterine space were 94.4% and 37.5% (P = 0.013), respectively. Other variables had no statistical significance. The diagnostic accuracy of CT colonography is higher than that of MRI (area under the curve, 0.786 vs 0.691; P < 0.001), for the overall rectosigmoid endometriosis. In the evaluation of complete cul-de-sac obliteration, morphologic change of rectosigmoid colon is identified more accurately with CT colonography than that of MRI (area under the curve, 0.821 vs 0.686; P < 0.001).
Both CT colonography and MRI are highly sensitive to the detection of rectosigmoid endometriosis, but lack specificity. However, the depiction rate of morphologic change in rectosigmoid colon is greater with CT colonography than that of MRI, in the case of cul-de-sac obliteration. The luminal alteration significantly correlates with morphologic change in rectosigmoid endometriosis.
我们旨在评估计算机断层扫描（CT）结肠成像对于累及直肠乙状结肠的深部浸润性子宫内膜异位症（DIE）的诊断价值和形态学特征，并与磁共振成像（MR）进行比较。
纳入50例术前接受过CT结肠成像和磁共振成像（MRI）检查的DIE患者。在这50例行腹腔镜手术的DIE患者中，37例被诊断为直肠乙状结肠子宫内膜异位症（直肠外壁受累、直肠子宫陷凹内膜植入以及陷凹完全闭塞且经组织学证实）。两名放射科医生对CT结肠成像和MRI的图像结果进行回顾，以确定是否存在有助于预测直肠乙状结肠子宫内膜异位症的影像学特征。分析CT图像上直肠乙状结肠的管腔改变、肠壁增厚以及直肠乙状结肠内的肿块形成情况，而分析MR图像上直肠乙状结肠内的肿块形成、直肠与子宫或阴道之间脂肪平面消失、子宫后倾、子宫向结肠回缩以及直肠阴道或直肠子宫陷凹内子宫内膜斑的检测情况。采用Pearson χ检验和受试者操作特征曲线进行统计学分析。
对于总体直肠乙状结肠子宫内膜异位症，CT结肠成像检测直肠乙状结肠管腔改变的敏感度为96.0%，特异度为48.0%（P<0.001）；对于伴有陷凹闭塞的DIE，敏感度为84.0%，特异度为80.0%（P = 0.005）。对于检测直肠乙状结肠或直肠子宫陷凹内的子宫内膜异位症，MR的敏感度和特异度分别为94.4%和37.5%（P = 0.013）。其他变量无统计学意义。对于总体直肠乙状结肠子宫内膜异位症，CT结肠成像的诊断准确性高于MRI（曲线下面积，0.786对0.691；P<0.001）。在评估陷凹完全闭塞时，CT结肠成像比MRI更能准确识别直肠乙状结肠的形态学改变（曲线下面积，0.821对0.686；P<0.001）。
CT结肠成像和MRI对直肠乙状结肠子宫内膜异位症的检测均高度敏感，但缺乏特异性。然而，在陷凹闭塞的情况下，CT结肠成像对直肠乙状结肠形态学改变的显示率高于MRI。直肠乙状结肠子宫内膜异位症的管腔改变与形态学改变显著相关。
