Kim Arane, Fernandez Pedro, Martin Brigitte, Palazzo Laurent, Ribeiro-Parenti Lara, Walker Francine, Bucau Margot, Collinot Helene, Luton Dominique, Koskas Martin
Department of Obstetrics and Gynecology, Bichat Hospital, Paris, France.
Department of Radiology, Bichat Hospital, Paris, France.
J Minim Invasive Gynecol. 2017 Nov-Dec;24(7):1218-1226. doi: 10.1016/j.jmig.2017.07.026. Epub 2017 Aug 9.
To compare the accuracies of magnetic resonance imaging (MRI) and rectal endoscopic sonography (RES) in the prediction of the infiltration depth of colorectal endometriosis.
A retrospective cohort study (Canadian Task Force classification II-2).
A university teaching hospital.
Forty patients with symptomatic deep infiltrating endometriosis (DIE) of the rectum who underwent colorectal resection were included.
All patients underwent abdominopelvic MRI and RES preoperatively to assess the infiltration depth of colorectal endometriosis, and segmental resection of the rectosigmoid by laparoscopy was performed if RES showed bowel invasion. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive and negative likelihood ratios (LRs), and intermethod agreement were calculated for DIE muscularis and submucosal/mucosal infiltration confirmed by histopathological analysis.
For MRI detection of DIE muscularis infiltration, the sensitivity, specificity, PPV, NPV, and negative LR were 68%, 100%, 100%, 20%, and 0.32, respectively. For the MRI detection of DIE submucosal/mucosal involvement, the sensitivity, specificity, PPV, NPV, and positive and negative LRs were 47%, 81%, 69%, 63%, 2.49, and 0.65, respectively. The PPV of RES detection of DIE muscularis infiltration was 93%. For the RES detection of DIE submucosal/mucosal layers, the sensitivity, specificity, PPV, NPV, and positive and negative LRs were 79%, 48%, 58%, 71%, 1.51, and 0.44, respectively.
In the current study, MRI is valuable for detecting endometriosis of the rectum but is less accurate in detecting submucosal/mucosal involvement than RES. Magnetic resonance imaging was not successful for preoperative determination of segmental resection versus a more conservative approach. When bowel involvement is detected by MRI, RES is not essential. When symptoms suggest DIE in patients without intestinal lesions detected by MRI, RES is necessary to exclude bowel invasion.
比较磁共振成像（MRI）和直肠内镜超声检查（RES）预测结直肠子宫内膜异位症浸润深度的准确性。
一项回顾性队列研究（加拿大工作组分类II-2）。
一所大学教学医院。
纳入40例因直肠症状性深部浸润性子宫内膜异位症（DIE）而接受结直肠切除术的患者。
所有患者术前均接受腹部盆腔MRI和RES检查，以评估结直肠子宫内膜异位症的浸润深度，若RES显示肠壁受侵，则行腹腔镜乙状结肠直肠节段切除术。计算经组织病理学分析证实的DIE肌层浸润及黏膜下层/黏膜浸润的敏感度、特异度、阳性预测值（PPV）、阴性预测值（NPV）、阳性和阴性似然比（LR）以及两种方法之间的一致性。
对于MRI检测DIE肌层浸润，敏感度、特异度、PPV、NPV和阴性LR分别为68%、100%、100%、20%和0.32。对于MRI检测DIE黏膜下层/黏膜受累，敏感度、特异度、PPV、NPV以及阳性和阴性LR分别为47%、81%、69%、63%、2.49和0.65。RES检测DIE肌层浸润的PPV为93%。对于RES检测DIE黏膜下层/黏膜层，敏感度、特异度、PPV、NPV以及阳性和阴性LR分别为79%、48%、58%、71%、1.51和0.44。
在本研究中，MRI对于检测直肠子宫内膜异位症有价值，但在检测黏膜下层/黏膜受累方面不如RES准确。MRI对于术前确定节段性切除与更保守的方法并不成功。当MRI检测到肠壁受累时，RES并非必需。当MRI未检测到肠道病变但患者有症状提示DIE时，RES对于排除肠壁受侵是必要的。
